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1,001 | Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency | The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, "I guess; I don't know." | First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, "He's getting all of this nonsense from school just to fit in, and it needs to stop." The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments. | The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being "understood" by his parents. He withdraws from his family quite often (will not leave his room) and usually has "screaming matches" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing "girlish ways." His son avoids contact sports but has expressed an interest in ballet. | What would be necessary for effectively dealing with the school administrative team regarding the client's current experience with bullying? | Ask his school counselor to attend your next session so the client has a safe space to explain what is happening at school | Request a firm date and meeting with the school counselor and administrative team and the child's parents, so they can express their consent and concerns in person. | Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety | Add a release of information sentence in your informed consent forms at the beginning of intake | (A): Ask his school counselor to attend your next session so the client has a safe space to explain what is happening at school
(B): Request a firm date and meeting with the school counselor and administrative team and the child's parents, so they can express their consent and concerns in person.
(C): Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety
(D): Add a release of information sentence in your informed consent forms at the beginning of intake | Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety | C | A release of information is a powerful tool that enables you, the outside therapist, to speak to the school counseling and admin team. This allows your client to feel supported and protected in the school environment. Therefore, the correct answer is (D) | professional practice and ethics |
1,002 | Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual | Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor. | Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs. | null | Prior to the next counseling session, the therapist felt weary about seeing Harold again. Upon reflection, the counselor realized that Harold reminded him of a past coworker who did not treat the counselor well. The best thing for the counselor to do in this situation is? | Speak to Harold about the issue | Terminate with Harold | Ignore the issue | Speak to his supervisor about the issue | (A): Speak to Harold about the issue
(B): Terminate with Harold
(C): Ignore the issue
(D): Speak to his supervisor about the issue | Speak to his supervisor about the issue | D | Countertransference occurs when the client brings up feelings in the therapist that have nothing to do with the client themselves but has to do with something within the therapist. In this instance it would be best for the counselor to speak to his/her supervisor to process what is occurring. Countertransference is a common occurrence, and it is not necessary for the counselor to terminate with Howard currently. Speaking to Harold about the issue would be inappropriate as the cause of the discomfort has nothing to do with what Harold has done and that would make the session about the counselor and not Harold. Ignoring the issue can result in negative consequences and would affect the quality of care Harold receives. Therefore, the correct answer is (B) | professional practice and ethics |
1,003 | Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0) | Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa | You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive. | Fifth Session, 5 Weeks After the Initial Intake The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening. While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services | While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services. Which of the following is the most ethical response in this supervisory relationship? | Consider termination of the supervisor/intern relationship. | Provide further coaching to improve their professionalism. | Sit in on a session to observe the intern’s behavior. | Initiate termination of the supervisor/intern relationship. | (A): Consider termination of the supervisor/intern relationship.
(B): Provide further coaching to improve their professionalism.
(C): Sit in on a session to observe the intern’s behavior.
(D): Initiate termination of the supervisor/intern relationship. | Initiate termination of the supervisor/intern relationship. | D | Despite providing coaching, the intern continues the problem behaviors, which has resulted in several clients aborting their sessions. It is apparent, at this point, that the intern is not willing to make changes and is actively harming clients, demonstrated by the client absences. For this reason, termination of the supervisor/intern relationship should be initiated (and not simply considered). If the intern is just starting to demonstrate unethical behavior, providing coaching and considering termination are appropriate actions, but these steps have already been taken. Observing a session would not be helpful because the intern likely would not engage in the problem behaviors during the session that you are watching. Furthermore, observation does not prioritize the best interest of the clients because the intern continues to engage in behavior that is harmful to them. Therefore, the correct answer is (C) | professional practice and ethics |
1,004 | Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent. | First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that "life has no meaning." She is seeking your help to find some relief. You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery. Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history. | The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities. | What information precludes you from diagnosing this client with Posttraumatic Stress Disorder (PTSD)? | The disorder does not cause enough significant dysfunction in the client’s life. | The client does meet the criteria for PTSD. | The traumatic event is too recent. | The client’s family issues seem to be part of the problem; a diagnosis is not needed. | (A): The disorder does not cause enough significant dysfunction in the client’s life.
(B): The client does meet the criteria for PTSD.
(C): The traumatic event is too recent.
(D): The client’s family issues seem to be part of the problem; a diagnosis is not needed. | The traumatic event is too recent. | C | The traumatic event occurred within the past two weeks. For a diagnosis of PTSD, the symptoms must last at least one month. Because the event is recent, the client's prognosis is better than having a PTSD diagnosis. Intervening soon after a traumatic event is important and can lead to better treatment outcomes. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,005 | Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4) | Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th | You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school. | Since the intake, you have provided professional development training for school staff on transgender and gender nonconforming (TGNC) individuals. The administration supports your recommendations for keeping the client and others safe at school. The client continues to miss school, but they have had fewer absences this month. You learn that the client’s desire to be rid of their male secondary sex characteristics has become more persistent. They say that they have seen media coverage of individuals who have undergone sex reassignment surgeries and wondered what that would be like. The client also states they are confused about their sexual orientation. The client appreciates being an active participant in their treatment, and together you create relevant treatment plan goals. You discuss the upcoming family session with the client’s parents. The client articulates appropriate topics for this session and reports increased anxiety concerning their father’s participation. Counselors must carefully examine the benefits and risks associated with medical interventions for adolescents with gender dysphoria | Counselors must carefully examine the benefits and risks associated with medical interventions for adolescents with gender dysphoria. Which ethical principle considers the client’s capacity to participate in the decision-making process? | Fidelity | Justice | Autonomy | Beneficence | (A): Fidelity
(B): Justice
(C): Autonomy
(D): Beneficence | Autonomy | C | Autonomy is the right of an individual to participate in decisions affecting the direction of their life. Autonomy is an integral part of informed consent. Informed consent is the process by which one understands the benefits and risks of a specific treatment and freely consents to that treatment. Counselors who work with TGNC teens are tasked with providing accurate information on the pros and cons of medical treatment for gender dysphoria. In general, counselors must educate families on the detrimental effects of withholding medical interventions, including increased psychiatric comorbidity (eg, suicidality, substance abuse). Alternatively, there are risks inherent in hormonal or surgical interventions, including the timing of administration and the irreversible nature of some of these interventions. Because the client is 13 years old, their ability to make an informed decision may not be developmentally appropriate, particularly for hormonal and surgical interventions. The principle of beneficence is honored by working for the good of the client’s overall mental health and wellbeing. Fidelity is the ethical principle that is used when keeping commitments and promises. Fidelity is most commonly practiced when conducting research and engaging with other professionals. Therefore, the correct answer is (D) | professional practice and ethics |
1,006 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital. | The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling. You colead the client’s process-oriented group with a trained counselor | You colead the client’s process-oriented group with a trained counselor. Which one of the following is LEAST indicative of a process-oriented group? | Identifying and discussing group themes and patterns | Allowing for the use of silence | Assessing intragroup interactions | Teaching the importance of medication compliance | (A): Identifying and discussing group themes and patterns
(B): Allowing for the use of silence
(C): Assessing intragroup interactions
(D): Teaching the importance of medication compliance | Teaching the importance of medication compliance | D | Teaching the importance of medication compliance is least indicative of a process-oriented group. Psychoeducational groups are content oriented and focus on teaching and conceptual learning. According to Yalom & Leszcz (2005), “While content involves looking at what specifically was said, process involves looking at the how and the why behind what was said” Trained counselors use process-oriented groups to assess interpersonal or intragroup interactions, introduce silence, and identify and discuss group themes and patterns. Although psychoeducation can be integrated into process groups, it is content oriented rather than process oriented. Therefore, the correct answer is (A) | counseling skills and interventions |
1,007 | Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1) | Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th | You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body. | e The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family. The client reports being treated for separation anxiety disorder in kindergarten | The client reports being treated for separation anxiety disorder in kindergarten. You think that the diagnosis is likely based on which of the following DSM-5-TR criteria? | Selective mutism when anticipating being away from home | Persistent and excessive fear of teachers and peers | Hypervigilance, poor concentration, and sleep disturbance | Repeated nightmares involving being away from home | (A): Selective mutism when anticipating being away from home
(B): Persistent and excessive fear of teachers and peers
(C): Hypervigilance, poor concentration, and sleep disturbance
(D): Repeated nightmares involving being away from home | Repeated nightmares involving being away from home | D | Repeated nightmares involving being away from home are criteria for separation anxiety disorder. Separation anxiety disorder is characterized by excessive fear of either being apart from or losing an attachment figure (eg, away from home). Persistent and excessive fear of teachers and peers is better explained by a specific phobia, whereas hypervigilance, poor concentration, and sleep disturbance may indicate a generalized anxiety disorder. Selective mutism is a form of anxiety in children associated with the failure to speak in social situations where there is the expectation that a child would do so. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,008 | Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0) | Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af | You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present. | fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend | Which of the following assessments would be the most effective in evaluating ADHD for this client? | An organizational assessment | Vineland Adaptive Behavior Scales | Vanderbilt ADHD Diagnostic Rating Scale | Conners Abbreviated Symptom Questionnaire | (A): An organizational assessment
(B): Vineland Adaptive Behavior Scales
(C): Vanderbilt ADHD Diagnostic Rating Scale
(D): Conners Abbreviated Symptom Questionnaire | Conners Abbreviated Symptom Questionnaire | D | According to a meta-analysis of ADHD questionnaires and assessment tools performed in 2016, the Conners Abbreviated Symptom Questionnaire is the most effective tool for screening for ADHD due to its ability to assess for positive and negative symptoms. This tool will be the most helpful because it probes functioning in many areas including work, home, school, and social functioning with ADHD. The Vanderbilt ADHD Diagnostic Rating Scale would not be appropriate for this patient because it assesses ages 6 through 12 for ADHD. The Vineland Adaptive Behavior Scales would also be inappropriate for this client because it is used for people ages 3 through 21. Although an organizational assessment may be helpful, it is not an approved means of diagnosing ADHD. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,009 | Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong. | First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an "emotional roller coaster" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you. Early on during the session, the client says, "Please help me. I know something is wrong, but I don't know what to do. Can you fix me?" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward. You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change. Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, "I bet my dad enjoys watching this from the grave," and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has "an epiphany" as she describes how she feels and realizes that he must have suffered a lot. Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos. At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time "just chilling" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session. | The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she "slipped on the last step of the staircase and fell into a door jam." She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was "not spiritual enough" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. | Which action demonstrates empathy for the client? | You acknowledge her feelings about her father. | You ask open-ended questions. | You share a story about your relationship with your father. | You assist her in identifying negative thought patterns. | (A): You acknowledge her feelings about her father.
(B): You ask open-ended questions.
(C): You share a story about your relationship with your father.
(D): You assist her in identifying negative thought patterns. | You acknowledge her feelings about her father. | A | Empathy is a powerful tool when used properly because the therapeutic relationship is considered curative in nature. The function of empathy is not merely to label emotional states but to recognize what it feels like to experience something. Empathy is considered the ability to understand and share the feelings of another. Kohut considers empathy to be the major tool of therapy. Therefore, the correct answer is (B) | counseling skills and interventions |
1,010 | Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School | Appearance: Female with crossed arms, avoiding eye contact, and a blank expression. Affect: Flat affect. Speech: Responses are brief and monotone, lacking emotion. Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation. Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported. Perception: No evidence of hallucinations or delusions. Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills. Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions. | First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that "it wasn't a surprise to get your phone call," as their daughter's behavior is poor at home, too. They are at their "wit's end" due to their daughter's constant "back talking" and "arguing" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts. Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus. Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors. Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor. You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings. Seventh session Today, you meet with Becky and both of her parents. Her father demands to be included in the treatment process. He is adamantly opposed to his daughter being placed in special classes, but the mother expresses her belief that placement in a special class is the best solution. The parents continue to disagree. Finally, Becky screamed out her support for her father's side of the argument. Becky's reaction in support of her father's position only further escalated the disagreement between her parents. Her mother seemed to be taken aback by Becky's outburst and tried to explain calmly why she believed special classes would be the best solution for their daughter. At this point, the conversation became more heated. Her mother expressed her frustration with her husband, saying he always seemed to take Becky's side regardless of the situation. This further agitated the father, and he began to raise his voice in protest. Sensing the tension in the room, Becky suddenly crossed the room and sat on her father's lap. The parents' discussion escalated into an argument, with Becky's mother finally walking out of the office. | The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students. Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. | The father has been forceful in stating his opinion regarding his daughter being placed in special classes. The daughter has shown an affinity for the father during the session. What would be the most appropriate response to this situation? | Recognizing that the parents are at an impasse and no further interactions are advisable, you should conclude therapy sessions. | You should engage the father to establish rapport and considering the strength of his opposition to special education classes, you should agree to his demands. | You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school. | You should engage the father to lead him to affirm the mother, as she seems to have the daughter's best interest in mind. | (A): Recognizing that the parents are at an impasse and no further interactions are advisable, you should conclude therapy sessions.
(B): You should engage the father to establish rapport and considering the strength of his opposition to special education classes, you should agree to his demands.
(C): You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school.
(D): You should engage the father to lead him to affirm the mother, as she seems to have the daughter's best interest in mind. | You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school. | C | Both parents have a right to express their opinions and feelings and to have a full explanation regarding the direction of their child's educational disposition. It is also important to be able to explore the nature of parental relationships in therapy. Therefore, the correct answer is (D) | counseling skills and interventions |
1,011 | Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual | Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.” | Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids. | Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice. | What focus of interventions would help Raul stay out of trouble in school? | delayed gratification | thought stopping | aversion therapy | mindfulness | (A): delayed gratification
(B): thought stopping
(C): aversion therapy
(D): mindfulness | delayed gratification | A | Teaching Raul how to delay gratification can greatly improve his impulse control while still helping him rationalize getting his needs met. This can be accomplished by practicing several skills after helping Raul prioritize his "wants" over his "needs" and working to achieve a "greater goal" later, rather than meeting lesser needs immediately. Working with Raul on what motivates him as well as helping him identify how he feels after he has indulged in an impulsive or compulsive action are ways to begin this process. Mindfulness would be challenging for Raul with inattentive type ADHD as he is unable to remain on task without constant guidance or direction. Aversion therapy contains tactics to help clients train their brains to avoid stressful stimuli (ie, snapping a rubber band on their wrist whenever they recognize they are having negative thoughts, with the intention that eventually they can redirect their thoughts without a snap to avoid the pain of the rubber band). Thought stopping technique has similar intentions in that it can help with intrusive negative thoughts or worry that often accompany phenomena like anxiety or panic attacks. Therefore, the correct answer is (D) | counseling skills and interventions |
1,012 | Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed | Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc | You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him. | The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations | How would an Adlerian therapist address the client’s depressive symptoms resulting from significant time spent on social media? | Examine the client’s unhealthy life position of “I’m not okay; you’re okay.” | Identify the activating event, beliefs, and consequences (i.e., the ABC model). | Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.” | Transform a failure identity into a success identity. | (A): Examine the client’s unhealthy life position of “I’m not okay; you’re okay.”
(B): Identify the activating event, beliefs, and consequences (i.e., the ABC model).
(C): Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.”
(D): Transform a failure identity into a success identity. | Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.” | C | Adlerian therapists emphasize the importance of social connection, asserting that all individuals strive for “superiority,” which is achieved through a purposeful, goal-oriented lifestyle. Adlerian therapists view maladjustment as the development of a mistaken style of life leading to feelings of inferiority. Transactional analysis uses positions such as “I’m not okay; you’re okay” to describe how one views themselves and others. Reality therapists would work to transform a failure identity into a success identity by emphasizing personal choice and a commitment to change. REBT therapists identify the activating event, behavior, and consequences of the behavior (ie, the ABC model) to help address irrational thinking. Therefore, the correct answer is (D) | counseling skills and interventions |
1,013 | Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice | The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people "annoying" and can at times be vindictive toward people he finds "annoying." His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor. | First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is "strict and unfair." Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, "She should be in therapy, not me." Gregory's mother continues on to express concern over his decline in school performance, noting that "he is having problems with some teachers and staff." Last week, he got up in the middle of class and when told to sit down, he said, "I have to go to the bathroom." He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, "because they think they're better than me." His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities. You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out. | The client resides with his mother and three older brothers. He describes his brothers and mother as "annoying" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him. The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death. The client denies drug or alcohol use and responds to your question, saying, "What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?" The client scoffed and continued, "Why would I waste my time and energy risking my future for something so pointless." He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further. | Which option is the best course of action to take when dealing with minors and confidentiality? | Let the minor know that you will inform his parent of session content to maintain open communication. because he has no right to privacy. | Let the minor know that you will maintain confidentiality, regardless of his parent's requests for access to session information | Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited. | Let the minor know that you will not share your personal therapy notes of the session with his parents. | (A): Let the minor know that you will inform his parent of session content to maintain open communication. because he has no right to privacy.
(B): Let the minor know that you will maintain confidentiality, regardless of his parent's requests for access to session information
(C): Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited.
(D): Let the minor know that you will not share your personal therapy notes of the session with his parents. | Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited. | C | A minor's privacy in therapy is limited. Individuals under eighteen do not typically have a right to confidentiality in therapy. Therefore, the correct answer is (D) | professional practice and ethics |
1,014 | Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined | Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with | You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics. | The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present | Which one of the following is an appropriate short-term goal for post-traumatic stress disorder? | Improve the client’s ability to talk about her traumatic experience. | Significantly reduce negative symptoms associated with the trauma. | Use cognitive behavioral strategies to reduce the daily impact of the trauma. | Reduce avoidance of triggers for trauma symptoms. | (A): Improve the client’s ability to talk about her traumatic experience.
(B): Significantly reduce negative symptoms associated with the trauma.
(C): Use cognitive behavioral strategies to reduce the daily impact of the trauma.
(D): Reduce avoidance of triggers for trauma symptoms. | Use cognitive behavioral strategies to reduce the daily impact of the trauma. | C | Using cognitive behavioral strategies to reduce the daily impact of trauma is the most relevant short-term goal for this client because it is achievable in the most immediate future. Reducing negative symptoms in a significant manner is not likely to occur in the short term, nor is reducing the avoidance of triggers, because it takes time to process a traumatic event and implement the coping skills necessary to achieve these goals. Talking about a traumatic experience is not always beneficial for clients and may, in fact, cause more harm. In the early stages of treatment following a traumatic event, it is often more beneficial to manage the effects of the trauma than to force conversations about it. Therefore, the correct answer is (D) | treatment planning |
1,015 | Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual | John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.” | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners. | Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment. | John appears to be responding to Cognitive Behavioral Therapy approaches. What is the best CBT-based intervention of the choices below for inclusion into John's treatment plan? | Selecting an effective medication proven to reduce anxiety and anger-related conditions | Processing his negative automatic thoughts in the form of a Thought Record | Learning and practicing meditation and deep breathing | Trauma-focused CBT treatment in which his daughter participates | (A): Selecting an effective medication proven to reduce anxiety and anger-related conditions
(B): Processing his negative automatic thoughts in the form of a Thought Record
(C): Learning and practicing meditation and deep breathing
(D): Trauma-focused CBT treatment in which his daughter participates | Processing his negative automatic thoughts in the form of a Thought Record | B | Medication selection does not belong underneath the scope of CBT-based interventions but can be considered and concurrently followed up with by a psychiatric provider. Meditation and deep breathing are practices incorporated within Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness can alter one's attitude towards one's thoughts so that their feelings and behaviors are affected less intensely or frequently, however CBT is focused on restructuring cognitive distortions and reframing beliefs towards more adaptive perspectives. TF-CBT is a family-focused treatment that does not seem to be appropriate without John having any form of relationship with his daughter or communication with her mother; although his daughter is of legal age to participate without parental consent. It is reasonable to select c) as the best option during this phase of John's treatment to assist him with identifying triggering events, understanding his feelings, and to become capable of differentiating between healthy and irrational patterns of thinking. Therefore, the correct answer is (C) | treatment planning |
1,016 | Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate. | First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace. You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior. Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work "only a few times" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care. As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation. | The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed. The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as "friends" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists. | When considering the possibility of implementing an experimental treatment with this client in the future, what is your initial responsibility towards the client? | Provide the client with the statistics that will positively influence his acceptance of the treatment due to the severity of the detrimental effects of his substance use. | Obtain informed consent before implementing procedures. | Contact the client's insurance company to determine if the treatment is covered or will be fee-for-service. | Consult with your supervisor regarding your intended treatment plan. | (A): Provide the client with the statistics that will positively influence his acceptance of the treatment due to the severity of the detrimental effects of his substance use.
(B): Obtain informed consent before implementing procedures.
(C): Contact the client's insurance company to determine if the treatment is covered or will be fee-for-service.
(D): Consult with your supervisor regarding your intended treatment plan. | Obtain informed consent before implementing procedures. | B | To fulfill your ethical responsibility as a therapist, you must inform the client of the procedures, risks, and possible outcomes of any alternative therapies implemented. Therefore, the correct answer is (A) | professional practice and ethics |
1,017 | Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency | The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying. | First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, "He was beaten to death because he was transgender." The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, "He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one." She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has "gotten out of hand." After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death. When asked what she is hoping to gain from therapy, she responds, "I just want to stop feeling so awful all the time." You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability. Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend. She says, "Why did he have to die? I feel like it's my fault." Next, you ask her, "What do you think caused your friend's death?" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings. Eighth session You have been seeing the client for a few months now, and she has consistently come to therapy and has made some progress, but some areas still need work. Regarding the death of her friend, she remains in the denial stage of his passing. She had been prescribed medication to help with her insomnia and depression, which seemed to be helping somewhat. In addition, she is limiting her alcohol intake, but she has not stopped drinking altogether. She had also been working on identifying her triggers for anxious distress, and you discussed several of them during previous sessions. Today, you focus on the stress the client reports in relationship to her job. You ask, "What has been going on at work that has been making you feel stressed out?" She starts to talk about her boss and seems to be caught up in the details, getting lost in her story. You notice her becoming agitated. You ask her to explain what she is feeling and she says, "overwhelmed, frustrated, and like I can't keep up." She tells you that just talking about it makes her feel physically uncomfortable. You offer the client some grounding techniques to help her stay in the present moment. You suggest she take a few deep breaths and focus on her breathing. You then ask her to focus on her physical sensations, including any tension or tightness in her body and gently encourage her to release that tension. You suggest she identify something in the room that can help her stay grounded and focus on it if her mind starts to wander. When she appears to be calm again, you ask her to describe the situation at work that is causing her the most distress in simple terms, without getting caught up in details. The client goes on to explain that her supervisor is often critical of her and she feels as though he does not appreciate the hard work she puts in. You listen to her and empathize, then encourage her to think about specific ways she can address the situation at work. You suggest that she start by making a list of her skills and competencies, so that she can remind herself of her worth when feeling attacked. Throughout the session, you mirror the client's body language by following her lead. When she leans forward, you lean forward. When she furrows her brows or crosses her arms, you do the same. You also make eye contact with the client, giving her your undivided attention. | The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, "It was like my dad leaving us just made everything worse." The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as "okay, but not something I'm passionate about." She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. | What intervention are you using when you provide the client with an article about anxiety and depression in the workplace and the struggles employees face due to stress? | Exposure therapy | Reattribution | Psychoeducation | Paradoxical intervention | (A): Exposure therapy
(B): Reattribution
(C): Psychoeducation
(D): Paradoxical intervention | Psychoeducation | C | Psychoeducation provides the client with tools and knowledge on the issues they are facing to help them cope. Therefore, the correct answer is (B) | counseling skills and interventions |
1,018 | Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22) | Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor | You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable. | The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her | Which is NOT true of the legal and ethical considerations for using personality inventories to conduct preemployment screening? | The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over. | Unless the employer can prove otherwise, using personality inventories can violate antidiscrimination laws for people belonging to certain groups (e.g., sex, race). | Interpretation and feedback for specific personality inventories must allow questions and clarification and avoid biased terms indicating that a particular personality preference is “not desirable.” | The reliability, validity, and psychometric limitations and appropriateness of instruments must be considered when selecting assessments for preemployment screening. | (A): The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over.
(B): Unless the employer can prove otherwise, using personality inventories can violate antidiscrimination laws for people belonging to certain groups (e.g., sex, race).
(C): Interpretation and feedback for specific personality inventories must allow questions and clarification and avoid biased terms indicating that a particular personality preference is “not desirable.”
(D): The reliability, validity, and psychometric limitations and appropriateness of instruments must be considered when selecting assessments for preemployment screening. | The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over. | A | The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those over the age of 40 rather than 50. The US Equal Employment Opportunity Commission bans employers from intentionally using personality tests and other selection procedures to discriminate against individuals based on religion, race, nationality, disability, sex, age, or color. Ethical guidelines for using personality tests, such as the Myers-Briggs Type Indicator, state that feedback and clarification must be sought when interpreting results. Test administrators must set aside time for questions and avoid biased terms indicating that a particular personality preference is “not desirable” Lastly, the ACA Code of Ethics states, “Counselors carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments and, when possible, use multiple forms of assessment, data, and/or instruments in forming conclusions, diagnoses, or recommendations”. Therefore, the correct answer is (B) | professional practice and ethics |
1,019 | Initial Intake: Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual | Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically. | Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session. | null | The counselor was able to get Elaina to relax by? | Defending the therapeutic process | Challenging the client | Establishing rapport | Establishing trust | (A): Defending the therapeutic process
(B): Challenging the client
(C): Establishing rapport
(D): Establishing trust | Establishing rapport | C | Rapport building is one of the first stages of the therapeutic process. Rapport is built when there is a positive feeling between counselor and client, there is a mutual understanding and positive communication. Challenging the client and defending the therapeutic process would not be advisable as way to put a client, who is frustrated, at ease. It is too early in the therapeutic process to have established trust. Therefore, the correct answer is (D) | counseling skills and interventions |
1,020 | Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5) | Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam | You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns. | The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter | How would a client with OCPD most likely approach termination? | Have a measured external reaction, is self-congratulatory, is indifferent toward the counselor | Feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence | Terminate too early, deny emotional reactions, and act dismissively toward the counselor | Attempt to delay termination and desperately cling to the counselor | (A): Have a measured external reaction, is self-congratulatory, is indifferent toward the counselor
(B): Feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence
(C): Terminate too early, deny emotional reactions, and act dismissively toward the counselor
(D): Attempt to delay termination and desperately cling to the counselor | Terminate too early, deny emotional reactions, and act dismissively toward the counselor | C | Individuals with OCDP experience pathological personality traits marked by avoidance and detachment. Individuals with avoidant attachment styles would react to termination in the same way they react to close romantic partners or interpersonal relationships, which is to remain emotionally detached. Individuals with disorganized attachment styles feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence. Individuals with ambivalent attachment styles attempt to delay termination and desperately cling to the counselor. Lastly, individuals with varied attachment styles, particularly those associated with narcissistic personality disorder, are self-congratulatory and detached. Therefore, the correct answer is (D) | professional practice and ethics |
1,021 | Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency | The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene. | First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection. Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered. | null | According to the Corey and Corey stages of group therapy model, what stage is this group currently in, and what stage might they move to next? | The group is experiencing anxiety and some members are having difficulty establishing trust with others.They are currently in the transition phase, not the initial phase. During the initial phase, the group members are getting acquainted with each other and establishing groups rules and norms. | Transition; Working | Initial; Transition | Working; Final | (A): The group is experiencing anxiety and some members are having difficulty establishing trust with others.They are currently in the transition phase, not the initial phase. During the initial phase, the group members are getting acquainted with each other and establishing groups rules and norms.
(B): Transition; Working
(C): Initial; Transition
(D): Working; Final | Transition; Working | B | The group is experiencing anxiety and some members are having difficulty establishing trust with others. During the transition stage, group members may experience anxiety, difficulty establishing trust with other group members and the group leader, and defensiveness. There may be conflicts between members and problem behaviors may become evident. The issues that have cropped up during the transition phase must be dealt with in order for the group to successfully navigate to the working stage. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,022 | Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual | Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly. | History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine. | null | Treatment of eating disorders include which of the following? | Both a and b | Teach coping skills to target anxiety of eating in front of others | Address addiction issues | Provide psychoeducation on the effect of social media on body image | (A): Both a and b
(B): Teach coping skills to target anxiety of eating in front of others
(C): Address addiction issues
(D): Provide psychoeducation on the effect of social media on body image | Both a and b | A | One of the main causes of eating disorders is the unrealistic portrayal of body images on social media. By providing psychoeducation about what a normal body looks like as well as how common eating disorders are, this may help Autumn realize that she is not alone. Teaching Autumn effective coping skills to manage her anxiety may allow her to feel more comfortable eating in front of others and allowing her to be part of the social setting of her cafeteria. There are no addiction issues indicated. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,023 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital. | The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals | Which of the following rational-emotive behavioral therapy (REBT) techniques is used to help identify the salient aspects of the client’s delusional belief system? | Normalizing | Emotion-based reasoning | Inference chaining | Linking | (A): Normalizing
(B): Emotion-based reasoning
(C): Inference chaining
(D): Linking | Inference chaining | C | Inference chaining is an REBT technique used to explore personal meanings associated with delusions. Inference chaining is used in rational-emotive therapy and is particularly effective for individuals experiencing delusions. The technique is used at the beginning of treatment to understand the underlying belief used to sustain the delusion. Linking is then used to gradually test reality by introducing other plausible explanations, with the overarching goal of decreasing distress created by the delusion. Normalizing is an effective cognitive-behavioral technique used to help process hallucinations. The stress-vulnerability model is used to normalize experiences associated with the onset of hallucinations and co-occurring stressors. Emotion-based reasoning was used by Aaron Beck, credited for developing cognitive-behavioral therapy. Emotional-based reasoning describes the maladaptive process in which delusions are categorized and involves believing that one’s emotional experiences dictate reality. Therefore, the correct answer is (A) | counseling skills and interventions |
1,024 | Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair. | First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as "Christine," although the father says "Christopher" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name. The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely. Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and "would like to work together." Fourth session The client has been "looking forward to working with you" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is "hard on her." She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father. | The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for "acting like a girl" and bully her on the playground. She is especially bullied by her male peers in school. The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. | When planning for the next session with the client and her father, what information should you ask your client to help make the best use of the joint session? | Exactly what patterns of interaction between the client and her father are creating distress for the client | What the client would like you to say to her father | What the client would like to say to her father with your support | If the client has thought of responses to her father, due to the high likelihood that it will end in conflict. | (A): Exactly what patterns of interaction between the client and her father are creating distress for the client
(B): What the client would like you to say to her father
(C): What the client would like to say to her father with your support
(D): If the client has thought of responses to her father, due to the high likelihood that it will end in conflict. | Exactly what patterns of interaction between the client and her father are creating distress for the client | A | This information will be valuable in planning behavioral interventions and can compare the client's perceptions with her father's. Therefore, the correct answer is (D) | counseling skills and interventions |
1,025 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual | Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling. | Diagnosis: Adjustment disorder with anxiety (F43.22)
You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions. | Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it. | You guide Taylor through the process of identifying her emotional reactions to her stressors, recognizing automatic thoughts, and challenging her underlying irrational belief systems through filling out a Thought Record. What is the end goal of this exercise? | To highlight her negative her core beliefs | To demonstrate how her feelings are irrational | To create a new, healthier thought process | To analyze each cognitive distortion individually | (A): To highlight her negative her core beliefs
(B): To demonstrate how her feelings are irrational
(C): To create a new, healthier thought process
(D): To analyze each cognitive distortion individually | To create a new, healthier thought process | C | If Taylor concludes that her unhelpful thinking styles are longer-term patterns that have been pervasive over time, this can be useful for her as motivation to change. Helping Taylor learn how her emotions affect her cognitions, which then affect her behaviors, is the purpose of Cognitive Behavioral therapy. The "Thought Record" is intended to support Taylor's cognitive restructuring process with the goal of training her mind to automatically develop healthier thoughts when faced with triggering situations. Within this process, her core beliefs, cognitive distortions, and irrational thoughts might be highlighted; but this is not the end goal. Additionally, feelings should never be presented as "irrational"; all feelings should be validated regardless of its origin of irrational thought. Therefore, the correct answer is (A) | counseling skills and interventions |
1,026 | Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs | Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety | You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI). | plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school | Which of the following is NOT is an established evidence-based component of a client’s safety plan? | Create an accessible list of emergency contacts and social supports to use when feeling suicidal. | Establish a “no suicide” safety contract. | Identify distractions to use when feeling suicidal (e.g., take a walk, call a friend). | Identify early warning signs (e.g., body shaming, isolation). | (A): Create an accessible list of emergency contacts and social supports to use when feeling suicidal.
(B): Establish a “no suicide” safety contract.
(C): Identify distractions to use when feeling suicidal (e.g., take a walk, call a friend).
(D): Identify early warning signs (e.g., body shaming, isolation). | Establish a “no suicide” safety contract. | B | There is no empirical evidence supporting no-suicide contracts for safety. Historically, clinicians have asked clients to sign no-suicide contracts indicating that they would not act on suicidal thoughts or reach out for support when experiencing suicidality. Not only do no-suicide contracts lack empirical evidence, but critics believe there can be an implication of coercion from the counselor due to concerns over professional protection and liability. Instead, a collaborative, strengths-based approach to safety planning is thought to empower the client and enhance the therapeutic alliance. There are various evidence-based components to treatment planning, including but not limited to: identifying early warning signs, using distractions when feeling suicidal, identifying social and emergency supports, identifying coping strategies, and making the environment safe. Therefore, the correct answer is (B) | treatment planning |
1,027 | Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency | Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age. Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport. Speech: Speech volume is normal, and speech flow is normal and spontaneous. Mood: The client's mood is dysphoric and anxious. Thought Process: Thought process is logical. Thoughts are negative. Affect: The client's affect is broad and appropriate to the discussion. Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment. Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average. | First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting. At the end of the session, the client turns to her husband and says, "I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him." Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner. | Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is "on the rocks.'" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, "I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do." | Overall, what are you executing when you demonstrate positive communication techniques that the couple could use with each other? | Narrative Therapy | Appropriate confrontation techniques | Exposure Therapy | Modeling Behavior | (A): Narrative Therapy
(B): Appropriate confrontation techniques
(C): Exposure Therapy
(D): Modeling Behavior | Modeling Behavior | D | By modeling, you will be able to demonstrate positive communication techniques which the client and her husband could begin to use with each other. Therefore, the correct answer is (C) | counseling skills and interventions |
1,028 | Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth | The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor. | First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to "go in a different direction." She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, "We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem." As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support. As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are "no more than hired help." You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you. You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as "competition." Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood. You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, "I'm an actress and have auditions. How long is this going to take?" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week. Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, "I see no reason to go on if he will only cause me grief." At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress. Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil. Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being. Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being. After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating. 11th session As the session begins, you sit calmly in your office, virtually watching as the client pounds her fists on her desk and speaks angrily. The client informs you that she is "not happy" with you as a therapist. "You therapists are all the same!" she yells. She accuses you of being responsible for her break-up, saying that her boyfriend left her because she had been hospitalized on your recommendation. Her facial expressions convey feelings of hurt and disappointment, and you attempt to normalize her reaction. You remain calm, opting to validate the client's feelings rather than respond defensively or deny responsibility for what has happened between the client and her partner. As the session continues, you take a deep breath and give yourself a moment to gather your thoughts. You recognize that the client's emotional pain and distress have created a lens through which she now views your professional relationship. Reflecting on the session and past interactions, you remember your concerns that prompted the recommendation for hospitalization. The client had exhibited signs of severe emotional distress and potential self-harm. As a therapist, you prioritized her safety and well-being. You understand her feelings of abandonment from her partner and try to determine who represents both care and potential harm in her life. However, no matter how much empathy you try to show or how many times you attempt to normalize the client's feelings of anger, she refuses any further discussion on the topic; instead, she declares firmly that she does not want to see you again and abruptly logs out of the session. You make a note to reach out to the client in a few days to check in on her well-being and see if she's open to discussing her feelings further. Given the intensity of her reaction, it's crucial to ensure that she has a support system during this challenging time. While she might not be receptive to your outreach initially, she needs to know that she is not alone and that help is available should she seek it. Later, you discuss the situation with your supervisor, seeking guidance on best handling her response and processing your feelings about the matter. The supervisor reminds you that therapeutic relationships can mirror many aspects of clients' other relationships. The anger and feelings of betrayal the client is experiencing could have been elicited by any number of events in her life. The most important thing is to continue offering support while respecting her boundaries. | The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures. Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress. Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling "distraught" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience. The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem. | How should you proceed, as the client has not completed the required number of mandated treatment sessions with you? | As a mandated reporter, immediately contact law enforcement or the courts to ensure she continues her sessions with you. | Inform the client that your agency will have to report to the appropriate legal entities that the client discontinued services and that it would be better if she stayed. | You are not responsible for the client's decisions. The client is accountable for her actions. | Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services. | (A): As a mandated reporter, immediately contact law enforcement or the courts to ensure she continues her sessions with you.
(B): Inform the client that your agency will have to report to the appropriate legal entities that the client discontinued services and that it would be better if she stayed.
(C): You are not responsible for the client's decisions. The client is accountable for her actions.
(D): Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services. | Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services. | D | This method respects the client's autonomy while also providing information about her treatment and the agency process (which requires informing entities that need to know about a client's treatment and progress). Therefore, the correct answer is (C) | treatment planning |
1,029 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1) | Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam | You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions. | The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process. You gather information to identify factors impeding the client’s progress | You gather information to identify factors impeding the client’s progress. How would you incorporate the influence of emotional, cognitive, and behavioral factors on the client’s clinical presentation and plan of care? | Summarize the client’s reasons for feeling stuck. | Obtain an interdisciplinary consultation. | Conduct a functional behavioral analysis. | Construct a case conceptualization. | (A): Summarize the client’s reasons for feeling stuck.
(B): Obtain an interdisciplinary consultation.
(C): Conduct a functional behavioral analysis.
(D): Construct a case conceptualization. | Construct a case conceptualization. | D | The best way to identify factors affecting the client’s clinical presentation and treatment plan goals is to construct a case conceptualization. Cognitive therapists promote the use of biopsychosocial assessments to assist in building a sound clinical presentation. Sperry and Sperry (2020) promote using the eight P’s when formulating the client’s case conceptualization; these include presentation, predisposition (including culture), precipitants, protective factors and strengths, pattern, perpetuants, (treatment) plan, and prognosis. Summarizing the client’s reasons for feeling stuck may help provide context to help understand the client’s views of himself, others, and the world; however, this option is incorrect because the client’s reasons for feeling stuck serve as the impetus for revisiting and updating the case conceptualization. Although it is also helpful, an interdisciplinary consultation is not the best process because there is no indication that the counselor lacks the skill set. Instead, the need arose due to the client’s shift in clinical presentation. The purpose of a functional behavioral analysis is to identify the client’s behavioral chain to determine which behaviors are desirable and which ones are undesirable. Once this is determined, the chain can be broken down and areas can be targeted to help lead to an improved outcome. By contrast, the case conceptualization analyzes a wide range of influences that change the client’s clinical presentation rather than looking at smaller components leading to behavioral change. Therefore, the correct answer is (A) | treatment planning |
1,030 | Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital | null | Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!” | null | Which of the following would be an inappropriate intervention at this time? | Assisting Kathleen and Tony in communicating to each other without blaming either | Providing psychoeducation on Tony's diagnosis | Focusing on trying to change Tony's behavior | Exploring Tony and Kathleen's support system | (A): Assisting Kathleen and Tony in communicating to each other without blaming either
(B): Providing psychoeducation on Tony's diagnosis
(C): Focusing on trying to change Tony's behavior
(D): Exploring Tony and Kathleen's support system | Focusing on trying to change Tony's behavior | C | Interventions in couples counseling should focus on the couple, aligning with the counseling modality. By assisting Kathleen and Tony in communicating in a more efficient manner, they can see each other's perspectives without becoming defensive. An example of this would be the use of "I" statements. By providing both with psychoeducation on Tony's diagnosis they can both have a common understanding and address misconceptions. By building up their natural supports, Tony and Kathleen will develop a support system which can continue when therapy ends. Therefore, the correct answer is (A) | counseling skills and interventions |
1,031 | Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately. | You are a counselor in a private practice setting. Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.” | Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose. | Which of the following interventions will be most beneficial for the client in this session? | Have the client make a list for why women are or are not "nuts or evil" | Relaxation exercises to help the client stay calm when he feels frustrated | Empty chair exercises allowing the client to talk to women he used to date | Role plays to help the client identify another person's perspectives | (A): Have the client make a list for why women are or are not "nuts or evil"
(B): Relaxation exercises to help the client stay calm when he feels frustrated
(C): Empty chair exercises allowing the client to talk to women he used to date
(D): Role plays to help the client identify another person's perspectives | Relaxation exercises to help the client stay calm when he feels frustrated | B | The client had demonstrated in this session that he struggles to allow others to have any control in relationships with him that interrupt having his needs met. This sense of entitlement demonstrates a tendency to see people as objects rather than individuals with their own needs, feelings, and perspectives. Role playing with the client can teach him how to listen and observe others in order to view them as people separate from him but still in relationship with him. Having the client list why or why not women are "nuts or evil" could be a good practice in helping him to see how he generalizes feelings about some women into all women. This may be helpful at another time but at this time, is not as important as helping relate to others to whom he has connections, such as in his current relationship. Relaxation exercises are helpful for managing negative emotions, but in this session, helping him control his emotions takes the focus away from the content that triggered his feelings. Empty chair exercises, like relaxation exercises, may be helpful later but currently it refocuses the session away from the triggering content that will be best processed immediately. Therefore, the correct answer is (B) | professional practice and ethics |
1,032 | Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12) | Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are | You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite. | You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning. In order to solidify your diagnosis of bipolar I disorder, the criteria for a major depressive episode must be met | In order to solidify your diagnosis of bipolar I disorder, the criteria for a major depressive episode must be met. All of the following are included on the list of possible criteria for a major depressive episode EXCEPT: | Suicidal thoughts | Catatonia | Decreased interest or pleasure in all activities | Difficulty concentrating | (A): Suicidal thoughts
(B): Catatonia
(C): Decreased interest or pleasure in all activities
(D): Difficulty concentrating | Catatonia | B | Catatonia is characterized by abnormal movement—either through a complete lack of movement or through repetitive movements—and it is not characteristic, nor a criterion, of a major depressive episode. Decreased interest or pleasure in activities, suicidal thoughts, and difficulty concentrating are all included in the DSM-5-TR list of possible criteria for the diagnosis of a major depressive episode. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,033 | Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation. | First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is "at her wit's end" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude. Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents. Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are "mean" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like "The Flash, the superhero who is the fastest human on Earth." You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age. You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits. You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others. | The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, "tries to get along" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away. | Which defense mechanism is the client illustrating by pretending he is The Flash? | Rationalization | Deflection | Reaction formation | Sublimation | (A): Rationalization
(B): Deflection
(C): Reaction formation
(D): Sublimation | Sublimation | D | Sublimation is a defense mechanism in which socially unacceptable impulses or idealizations are transformed into socially acceptable actions or behavior. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,034 | Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual | John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.” | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners. | Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment. | You begin to see John's unhealthy thought patterns re-emerge, inciting him to frustration. You respond, "Well despite your frustrations it shows great progress that you are willing to work on yourself before seeing them again. What motivates you to continue counseling?" This response is an example of? | Emphasizing personal choice and control | Foundational listening, attending, and reflecting skills | Encouragement and validation | Empathic responding and attunement | (A): Emphasizing personal choice and control
(B): Foundational listening, attending, and reflecting skills
(C): Encouragement and validation
(D): Empathic responding and attunement | Emphasizing personal choice and control | A | By pointing out John's choice to address his treatment plan goals before making further destructive choices that might negatively affect his family, you are reinforcing John's level of control in his life and relationships. Asking him to reflect on his motivation further emphasizes his commitment to working on achieving his goals. Therefore, the correct answer is (D) | counseling skills and interventions |
1,035 | Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1) | Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f | You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic. | You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others. Many members of your group are diagnosed with conduct disorder | Many members of your group are diagnosed with conduct disorder. Which one of the following is a key characteristic of conduct disorder? | Patterns of behavior in which the basic rights, rules, or norms of others are violated | Opposition to authority and rules | Persistent failure to resist the urge to steal objects that are not needed from others | Impulsive anger outbursts with rapid onset | (A): Patterns of behavior in which the basic rights, rules, or norms of others are violated
(B): Opposition to authority and rules
(C): Persistent failure to resist the urge to steal objects that are not needed from others
(D): Impulsive anger outbursts with rapid onset | Patterns of behavior in which the basic rights, rules, or norms of others are violated | A | A key characteristic of conduct disorder is the violation of the rights, rules, or norms of others. This characteristic is also present with antisocial personality disorder; however, conduct disorder is often the more appropriate diagnosis for adolescents and children. Opposition to authority and rules is a characteristic of oppositional defiant disorder. Impulsive anger outbursts with rapid onset are characteristics of intermittent explosive disorder. The difficulty with refraining from taking others’ items is characteristic of kleptomania. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,036 | Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate | Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent | You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.” | . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation | Of the following diagnoses, which is highly comorbid with BED? | Borderline personality disorder | Generalized anxiety disorder | Post-traumatic stress disorder | Obsessive-compulsive disorder | (A): Borderline personality disorder
(B): Generalized anxiety disorder
(C): Post-traumatic stress disorder
(D): Obsessive-compulsive disorder | Generalized anxiety disorder | B | There is a high comorbidity rate with general anxiety disorder and BED. According to the DSM-5-TR, the most common comorbid disorders for BED include bipolar disorders, depressive disorders, anxiety disorders, with substance use disorders occasionally found as well. Borderline personality disorder is a differential diagnosis rather than a comorbid condition. The DSM-5-TR includes binge eating in the impulsive behavior criterion as part of borderline personality disorder. Both diagnoses should be assigned if an individual meets full criteria for borderline personality disorder and binge-eating disorder. Post-traumatic stress disorder and obsessive-compulsive disorder are no longer classified as anxiety disorders. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,037 | Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0) | Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th | You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species. | e The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services. The client readily provides consent for you to speak to his mother; however, he tells you he will just meet with you for the intake and does not wish to sign an informed consent | The client readily provides consent for you to speak to his mother; however, he tells you he will just meet with you for the intake and does not wish to sign an informed consent. How should you proceed? | Do not move forward with the intake due to the need to honor the client’s autonomy. | Do not move forward with the intake due to the client’s limited capacity to provide consent. | Move forward with the intake without signed consent due to the need to assess safety and risk. | Move forward with the intake after obtaining the mother’s written consent. | (A): Do not move forward with the intake due to the need to honor the client’s autonomy.
(B): Do not move forward with the intake due to the client’s limited capacity to provide consent.
(C): Move forward with the intake without signed consent due to the need to assess safety and risk.
(D): Move forward with the intake after obtaining the mother’s written consent. | Move forward with the intake without signed consent due to the need to assess safety and risk. | C | While the client refuses to sign an informed consent, he already verbally agreed to participating in the intake, therefore moving forward with that intake and assessing for safety and risk is the most appropriate next steps. Informed consent is not required in rare instances when there is a significant risk instead of a slight or remote risk. Considerations for determining significant risk include its frequency, type, severity, and duration. Additionally, there must be a determination that the behavior can or cannot be mitigated by reasonable interventions. The APA Code of Ethics (2014) defines informed consent as “a process of information sharing associated with possible actions clients may choose to take, aimed at assisting clients in acquiring a full appreciation and understanding of the facts and implications of a given action or actions” Clients must be deemed competent and have the capacity to provide voluntary consent. The client has a 36 GPA and an unremarkable mental status exam, indicating competency. Allowing the mother to provide informed consent is incorrect due to the client’s competency and the fact that he is now 18. Therefore, the correct answer is (C) | professional practice and ethics |
1,038 | Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate. | First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace. You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior. Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work "only a few times" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care. As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation. | The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed. The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as "friends" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists. | Which statement best represents the use of paraphrasing? | "Sounds like you believe drinking is not an issue for you, but I believe that it is actually a problem." | "So, you use alcohol to cope with stress, and you see no problem with having a drink before work and at lunch. Further, you suspect that your boss has it in for you." | "I am interested in understanding more about why you feel that drinking is not the problem. Can you tell me more about that?" | "Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?" | (A): "Sounds like you believe drinking is not an issue for you, but I believe that it is actually a problem."
(B): "So, you use alcohol to cope with stress, and you see no problem with having a drink before work and at lunch. Further, you suspect that your boss has it in for you."
(C): "I am interested in understanding more about why you feel that drinking is not the problem. Can you tell me more about that?"
(D): "Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?" | "Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?" | D | The idea is to communicate by seeing the issue from the client's perspective and going from there. Paraphrasing can be a helpful way to do this. With paraphrasing, you affirm the client's view with empathy and support whether you agree with it or not. Paraphrasing helps you say what you heard in a non-judgmental way. Therefore, the correct answer is (C) | counseling skills and interventions |
1,039 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1) | Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam | You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions. | ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years. The client is unsure of his insurance benefits and allotted counseling sessions | The client is unsure of his insurance benefits and allotted counseling sessions. You review his benefits plan and any associated fees as part of which of the following? | The confidentiality agreement | The process of informed consent | An explanation of limitations | The client’s privacy rights | (A): The confidentiality agreement
(B): The process of informed consent
(C): An explanation of limitations
(D): The client’s privacy rights | The process of informed consent | B | The process of informed consent includes reviewing with the client payment, fees, and insurance benefits, including policies and procedures for nonpayment. Practitioners provide informed consent on an ongoing basis throughout the counseling relationship. Informed consent includes all of the essential information for the client to make an informed decision about receiving services. Other aspects of informed consent include the potential risks and benefits of counseling, emergency procedures, the overall purpose and goals, counselor credentials, and the role of technology. The confidentiality agreement is also part of informed consent. Privacy involves keeping confidential information secure. Therefore, privacy and confidentiality fall under the client’s rights and responsibilities section of informed consent. Lastly, an explanation of limitations is part of the confidentiality agreement and refers to informing clients of the circumstances in which a breach of confidentiality may occur. Therefore, the correct answer is (D) | professional practice and ethics |
1,040 | Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School | The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say "hi," and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date. | First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a "toddler-like" voice to sit in the seat. The mother tells you that the client is becoming increasingly "violent" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him "the education he deserves". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses. You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process. Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him "good job." The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others. Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan. Ninth session The client's one-on-one aide presents to this session with the client. The client is crying and having difficulties following the aid's directives in the hallway. You walk into the hall and show the client a picture with "a quiet sign." You open your door, and he reluctantly walks in and begins to kick the toy bins. You show him the "no" visual sign and shake your head no. You sit on the floor quietly until he joins you on the floor. You pull out a deck of visual cue cards and place them in front of him. He points to a picture of a boy being mean to another classmate, then starts to cry harder. You allow some extra time for the client to process his emotions. You then explain to him that it is not okay to kick the toy bin, and that he can use his words or draw pictures of what he feels instead. You provide reassurance that you are there to help him learn how to control his feelings in a better way. You then select some calming activities such as squeezing the stress ball and playing a matching game. As he begins to gain control of his emotions, you reinforce positive behaviors with verbal praise and approval. Throughout the session, you actively listen and provide opportunities for him to express himself in whatever manner is comfortable to him. You end the session by drawing a picture of yourself and your client, with both of you smiling together. You explain that this is what happens when you work together to find positive ways to cope with emotions. | The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. | What will work best in facilitating trust and safety at school for this client? | Role play the bullying and explore appropriate responses with the visual cards | Contact the client's parents and school regarding the potential bullying issues | Allow the client to take the stress ball with him to class | Monitor the client's routine to provide more supervised relational time | (A): Role play the bullying and explore appropriate responses with the visual cards
(B): Contact the client's parents and school regarding the potential bullying issues
(C): Allow the client to take the stress ball with him to class
(D): Monitor the client's routine to provide more supervised relational time | Contact the client's parents and school regarding the potential bullying issues | B | Addressing the bullying directly would be the most appropriate choice to facilitate trust and safety at school for this client. Therefore, the correct answer is (A) | professional practice and ethics |
1,041 | Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, "even though there is nothing to be angry about." You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry. | First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels "anger," but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them. The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood. The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them. At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is "guaranteed" a spot. You can accommodate his request and plan to see him again in one week. Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior. Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships. | null | What would be the best method to evaluate the client's current relational interactions? | Suggest that he invite his children to attend the next session | Invite him to create a family genogram | Explore his early childhood patterns of communication | Discuss instances in which he feels a positive connection with others | (A): Suggest that he invite his children to attend the next session
(B): Invite him to create a family genogram
(C): Explore his early childhood patterns of communication
(D): Discuss instances in which he feels a positive connection with others | Suggest that he invite his children to attend the next session | A | The idea is to see how he interacts in a relational context. Ultimately, the intention is to improve the client's relationships and to provide him with the skills necessary to build closeness with others. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,042 | Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility | The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor. | First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been "serious problems" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use "got out of control." Although he has been able to maintain sobriety for two years, he says that his wife is "paranoid" that he is using again and insists on knowing where he is "every minute of the day." He further reports that his wife is "too dependent" on him, and he feels "suffocated." He says, "I just can't keep doing this" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, "Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him." She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, "he just gets mad and leaves the room." Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again. Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, "That's not true!" and proceeds to tell you that she "caught" him holding a bottle of liquor in their garage this morning. The husband replies, "I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?" She replies, "I really want to believe you, but you make it really hard to do that." He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, "Fine. You know where to find me." The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words. You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to "make things right" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship. After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city. Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, "I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions. You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, "I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too." You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support. | The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father. | How would you demonstrate congruence with the wife during this session? | Show genuine interest in her thoughts, feelings, and experiences | Ask her clarifying questions to further understand her situation | Discuss resources to help her with her financial situation | Sit up, lean toward the client, and make eye contact as she speaks. | (A): Show genuine interest in her thoughts, feelings, and experiences
(B): Ask her clarifying questions to further understand her situation
(C): Discuss resources to help her with her financial situation
(D): Sit up, lean toward the client, and make eye contact as she speaks. | Show genuine interest in her thoughts, feelings, and experiences | A | Congruence is a technique used in counseling that focuses on creating a genuine connection between the counselor and the client. It involves being fully present with the client and honest about one’s reactions and feelings without judgment. In this session, you demonstrate congruence by offering the client emotional support and empathy. You acknowledge her feelings without judgment and let her know you are there to listen and support her. Therefore, the correct answer is (A) | counseling skills and interventions |
1,043 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family | Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks. | Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance. | Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support. | Shania often reprimanded her daughter before communicating her desired behaviors and became frustrated easily when she did not respond immediately. What suggestion should you not offer Shania? | Try setting expectations and giving Malia adequate time to follow through. | Look into free parenting seminars online or in your local community. | Consider joining a social media group for moms of kids with ADHD. | Don't reprimand Malia when she does not follow directions. | (A): Try setting expectations and giving Malia adequate time to follow through.
(B): Look into free parenting seminars online or in your local community.
(C): Consider joining a social media group for moms of kids with ADHD.
(D): Don't reprimand Malia when she does not follow directions. | Don't reprimand Malia when she does not follow directions. | D | All these suggestions would be helpful for Shania with the exception of answer d), as it may be appropriate at times to reprimand Malia for defiance. However, working with Shania on how to recognize defiance from inattention or lack of comprehension will be useful in addressing her frustration tolerance and improving communication with her daughter. Therefore, the correct answer is (D) | counseling skills and interventions |
1,044 | Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency | The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation. | First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his "last chance". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story. She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line "wasn't moving fast enough". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, "It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me." As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve. After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, "It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair." His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, "Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together." The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family. | The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a "bully" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a "troublemaker". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. | Which of the following assessments would be the most appropriate tool to use to evaluate the client's behavioral issues? | Conners Rating Scale | Social Responsiveness Scale | Child Behavior Checklist | The TWEAK Test | (A): Conners Rating Scale
(B): Social Responsiveness Scale
(C): Child Behavior Checklist
(D): The TWEAK Test | Child Behavior Checklist | C | This checklist is used to detect behavioral and emotional problems in children and adolescents and would be most appropriate to use in this case. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,045 | Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her. |
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions. | Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.” | Why was Lottie diagnosed with code F43.9 instead of F43.1? | It is an error; F43.1 is the correct code for Reaction to severe stress | F43.1 is a milder stress condition | She did not meet criteria for diagnosis of F43.1 | She must show symptoms of F43.9 for over 6 months to qualify for F43.1 | (A): It is an error; F43.1 is the correct code for Reaction to severe stress
(B): F43.1 is a milder stress condition
(C): She did not meet criteria for diagnosis of F43.1
(D): She must show symptoms of F43.9 for over 6 months to qualify for F43.1 | She did not meet criteria for diagnosis of F43.1 | C | F431 is the diagnostic code in the DSM-5 for Post-traumatic stress disorder (PTSD) and Lottie did not meet criteria when assessed for symptoms. Answers a), b) and d) are all false. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,046 | Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control. She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes. | You are a counselor in a private practice setting. During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex. | Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births. | In planning treatment goals for this client, which of the following would be the most effective counseling goal for this diagnosis? | Encourage client's husband to attend marital counseling to strengthen relationship | Explore childhood neglect and/or abuse, often related to body dysmorphic disorder | Challenge automatic negative thoughts about body image | Identify a support system that reassures client that she is attractive | (A): Encourage client's husband to attend marital counseling to strengthen relationship
(B): Explore childhood neglect and/or abuse, often related to body dysmorphic disorder
(C): Challenge automatic negative thoughts about body image
(D): Identify a support system that reassures client that she is attractive | Challenge automatic negative thoughts about body image | C | Cognitive behavioral interventions such as challenging automatic thoughts is the standard treatment for body dysmorphic disorder. Childhood neglect and abuse are often related to body dysmorphic disorder, and exploring these may facilitate client insight, which can be helpful in actual treatment. Effective treatment of this disorder requires the client to reduce reassurance seeking behaviors. Having a support system that provides the reassurance the client constantly is seeking does not help the client reduce her own anxiety about her body image or the need for constant reassurance. Having the client's husband attend therapy to focus on the relationship is not likely to reduce the client's body dysmorphia symptomatology as it is an ingrained pattern. Therefore, the correct answer is (A) | counseling skills and interventions |
1,047 | Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3) | Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam | You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” | The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love. You model a dialectical stance for the client by providing acceptance while simultaneously facilitating change | You model a dialectical stance for the client by providing acceptance while simultaneously facilitating change. This is a process known as which of the following? | Validation | Clarification | Confirmation | Affirmation | (A): Validation
(B): Clarification
(C): Confirmation
(D): Affirmation | Validation | A | Validation refers to a counselor’s ability to provide acceptance while simultaneously facilitating change. Engaging in this paradox exemplifies a dialectical stance, which is to hold two seemingly opposed truths. It is a practice of dialectical behavior therapy that can help decrease the client’s physiological and psychological arousal. In general, affirmations are statements acknowledging an individual’s positive qualities or capabilities. Counselors use confirmation when establishing truth or certainty. Clarification is used when counselors seek understanding when ideas are expressed when statements are contradictory or difficult to understand. Therefore, the correct answer is (A) | counseling skills and interventions |
1,048 | Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions. | You are a counselor in a private practice setting. Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly. Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.” | Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting. | Which of the following will be most helpful for assessing this client for ADHD? | Vanderbilt Assessment Scales (VAS) | Behavior Assessment System for Children (BASC) Parent Rating Scale | Test of Variables of Attention (TOVA) | Conners Rating Scale for ADHD (CRS) | (A): Vanderbilt Assessment Scales (VAS)
(B): Behavior Assessment System for Children (BASC) Parent Rating Scale
(C): Test of Variables of Attention (TOVA)
(D): Conners Rating Scale for ADHD (CRS) | Test of Variables of Attention (TOVA) | C | The TOVA is a computerized test system that can be used to assess adults (and children) for both inattentive and hyperactive types of attention deficit disorder. The BASC, CRS, and VAS are rating scales for testing children only. The BASC Parent Rating scale is used for the parent to provide observations of their child's attention and activity, which a clinician will use with other data to determine or rule out a potential ADHD diagnosis. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,049 | 7 Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual | Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.
Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone | Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement. | llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.
Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone. | Which of the following treatment areas can be ruled out? | Conduct disorder | Eating disorder | Complicated grief | Post-traumatic reaction | (A): Conduct disorder
(B): Eating disorder
(C): Complicated grief
(D): Post-traumatic reaction | Conduct disorder | A | Conduct disorder is typically given to children under age 18 and is a repetitive and persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated and at least three of fifteen criteria are met over the past 12 months; Millie is over 18, and while she has two areas of conduct-like behaviors, they might also be better explained by other contributing factors. Millie's case presents with several pieces of information that could warrant treatment in the areas of eating disordered behavior, grief and loss, and treatment of post traumatic reactions. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,050 | Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center | The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety. | First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, "About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it." She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack. She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, "I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense." As she wipes tears from her eyes, she shares, "I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband." She tells you that she had a "bad experience" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never "get better." She also states she feels like a "bad wife and mother" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her. | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal. The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. | You find it difficult to establish rapport with the client during the intake session as she spends most of the time talking and not listening to anything that you say. Which of the following is least helpful for building rapport? | Affirm the client's willingness to start therapy | Assess the client's presenting problem | Help the client understand the therapy process | Discuss what the client can expect in therapy | (A): Affirm the client's willingness to start therapy
(B): Assess the client's presenting problem
(C): Help the client understand the therapy process
(D): Discuss what the client can expect in therapy | Assess the client's presenting problem | B | Assessing the client's presenting problem is not an appropriate method to build rapport with the client as it does not help you relate to the client. Instead, it is an assessment tool. In addition, building rapport requires communication and conversation, so assessing the client's presenting problem would not be an effective way to connect with the client. Instead, more open-ended questions or statements that invite the client to talk and share their thoughts, feelings, and experiences are a better way to build rapport. Questions about the client's interests, hobbies, or family can also be used to start building a connection with them. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,051 | Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3) | Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea | You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library. | ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression. You meet with the client and her grandmother to create a genogram so you can assess the family’s multigenerational transmission process | You meet with the client and her grandmother to create a genogram so you can assess the family’s multigenerational transmission process. Which one of the following family theorists is known for this technique? | Jay Haley | Murray Bowen | Salvador Minuchin | Virginia Satir | (A): Jay Haley
(B): Murray Bowen
(C): Salvador Minuchin
(D): Virginia Satir | Murray Bowen | B | Murray Bowen is known for multigenerational (extended) family systems therapy. The multigenerational transmission process is a Bowenian technique used to assess how a family’s dysfunctional interactions can be handed down from generation to generation. Bowen was the first to introduce the genogram, a visual depiction of a family’s generational interactions, and significant patterns of relationships. Salvador Minuchin is associated with structural family therapy. Jay Haley is known for strategic family therapy. Finally, Virginia Satir pioneered the human validation process model of family therapy. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,052 | Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5) | Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam | You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns. | The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client. While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them | While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them.” This is an example of which one of the following? | Confrontation | Reframing | Interpretation | Empathetic attunement | (A): Confrontation
(B): Reframing
(C): Interpretation
(D): Empathetic attunement | Confrontation | A | This statement is an example of confrontation. Effective confrontation promotes greater awareness and insight by pointing out discrepancies in clients’ thoughts, words, or actions. The goal of confrontation is to reduce resistance by calling attention to the incongruence between clients’ expressed values and their behaviors. Counselors use interpretation to test a hypothesis or theory about a client’s experiences or inner thoughts and feelings. Reframing is used when counselors rephrase a client’s statement in a way that offers a different perspective or optimistic viewpoint. Counselors express empathetic attunement by becoming in sync with a client’s inner feelings or emotional state. Therefore, the correct answer is (B) | counseling skills and interventions |
1,053 | Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her. |
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions. | Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.” | Disagreeing with Lottie's mom's opinion on her medication needs, you decide to speak with her later about it. How should you explain to mom the reasons for your psychiatric referral? | She will not be successful without medication. | Medication will also resolve her oppositional defiance. | Untreated symptoms of ADHD are hindering growth. | You can't get her to do your assignments. | (A): She will not be successful without medication.
(B): Medication will also resolve her oppositional defiance.
(C): Untreated symptoms of ADHD are hindering growth.
(D): You can't get her to do your assignments. | Untreated symptoms of ADHD are hindering growth. | C | Lottie has endorsed that medication was once helpful to her, and that she wants to return to using it. She is clearly having undesired difficulty with her symptoms and is not progressing in treatment as she should. You recall the family's insurance is now active and can therefore possibly cover the cost of medications, should a psychiatric evaluation warrant them. Submitting a referral for her evaluation is appropriate and her mother's refusal to do so without good reason could be considered neglect. Medication will not necessarily resolve Lottie's ODD symptoms but can aid in her impulse control. Lottie can become successful with interventions other than use of medication, but her unwillingness to do work with you in session is not criteria for prescribing medication. The consequence of not working on assignments could be a lack of growth, which is why in speaking to Lottie's mom, who may be resistant to the idea of medication, the idea of submitting a referral for her evaluation should be prioritized. Either way, without properly treating ADHD, it will be much harder to isolate and treat symptoms from other disorders. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,054 | Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs | Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety | You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI). | The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy | Which one of the following is NOT a characteristic method of CBT? | The assignment of homework | Use of Socratic questioning | An emphasis on unconscious experiences | An approach that is structured and directive | (A): The assignment of homework
(B): Use of Socratic questioning
(C): An emphasis on unconscious experiences
(D): An approach that is structured and directive | An emphasis on unconscious experiences | C | Unlike therapies such as psychoanalysis, CBT does not emphasize unconscious experiences. Completing homework is an expectation of CBT, which is necessary for applying what is learned in therapy to real-world experiences. CBT practitioners use Socratic questioning to help understand the client’s underlying cognitions. CBT is a structured and directive approach, with the counselor working collaboratively with the client and functioning as a coach or teacher. Therefore, the correct answer is (C) | counseling skills and interventions |
1,055 | Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic | The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting. | First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is "down in the dumps" most of the time. When asked why he left the Navy, he replies: "Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day." Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore." Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD. The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later. The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds. | The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest. During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis. The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine. | When a client presents with a mild neurocognitive disorder (NCD) due to traumatic brain injury and meets criteria for an affective disorder, which is the most appropriate method to relay diagnosis to the client and other professionals? | Create and code the diagnosis for the affective disorder. | The primary concern should not include the diagnosis of the affective disorder. | Diagnose the affective disorder and pay no attention to NCD, as affective disorders require more extensive treatment. | Include a diagnostic specifier stating that criteria for an affective disorder are met. | (A): Create and code the diagnosis for the affective disorder.
(B): The primary concern should not include the diagnosis of the affective disorder.
(C): Diagnose the affective disorder and pay no attention to NCD, as affective disorders require more extensive treatment.
(D): Include a diagnostic specifier stating that criteria for an affective disorder are met. | Create and code the diagnosis for the affective disorder. | A | If full criteria for an affective disorder are met, this is the most appropriate method to relay the information. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,056 | Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed. | First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, "I keep hurting him. One day I love him, and the next day I can't look at him." She pauses and asks, "What if he leaves me? I can't deal with that." She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness. The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others. She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life. The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress. | The client's father died when she was very young. She describes her mother as having a "difficult time raising me and my brother as a single mother." The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern. | While in the initial assessment interview with the client, what action would you take to devise a provisional diagnosis for Borderline Personality Disorder? | Apply assessment instruments that evaluate the client's needs | Assess the support network the client utilizes | Gather information about the client’s history of the presenting problem | Provide psychoeducation related to Borderline Personality Disorder and assess whether the client can relate to the diagnosis | (A): Apply assessment instruments that evaluate the client's needs
(B): Assess the support network the client utilizes
(C): Gather information about the client’s history of the presenting problem
(D): Provide psychoeducation related to Borderline Personality Disorder and assess whether the client can relate to the diagnosis | Gather information about the client’s history of the presenting problem | C | Gathering information about the client's history of the presenting problem is the correct choice because this can lead you to a provisional diagnosis for BPD. When considering a diagnosis, it is necessary to determine the frequency, intensity, and duration of symptoms, functioning level, and medication or substance use. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,057 | Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues. He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg. | You are a counselor in a community agency setting. Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports. | Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done. | Which of the following will be most helpful for the client to initially manage his intense feelings when he hears something that is perceived as criticism? | Exposing the client slowly to greater amounts of negative feedback while in session | Help client determine when "tuning out" is appropriate | Work with client on empathy exercises so he can see other perspectives | Teaching and practicing relaxation exercises with the client during aroused states | (A): Exposing the client slowly to greater amounts of negative feedback while in session
(B): Help client determine when "tuning out" is appropriate
(C): Work with client on empathy exercises so he can see other perspectives
(D): Teaching and practicing relaxation exercises with the client during aroused states | Teaching and practicing relaxation exercises with the client during aroused states | D | Teaching the client and having him practice relaxation exercises is the most appropriate intervention at this time. By implementing relaxation exercises in the moment, he is more likely to not speak or act out of hurt and anger, but will provide himself time to gather his feelings prior to responding. This is a helpful behavioral step initially, and in the future, will be combined with empathy training and self-esteem work to strengthen his own intrapsychic feelings about himself. Prolonged exposure helps an individual to gradually become more comfortable with situations that cause high emotions or anxiety. However, using criticism as exposure to a client with fragile self-esteem will cause greater self-esteem injuries and will threaten the therapeutic relationship. Encouraging one to use a defense mechanism that threatens one's relationships is not an appropriate intervention. Therefore, the correct answer is (A) | counseling skills and interventions |
1,058 | Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine | Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns. | Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed. |
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation. | What is a question you should ask Leah to help diagnose or rule out PTSD? | Did you experience any physical injuries to the head? | Do you experience recurrent triggering dreams since any of your traumas? | Do you frequently have unpleasant memories? | Do you feel the urge to share your traumatic experiences with everyone? | (A): Did you experience any physical injuries to the head?
(B): Do you experience recurrent triggering dreams since any of your traumas?
(C): Do you frequently have unpleasant memories?
(D): Do you feel the urge to share your traumatic experiences with everyone? | Do you experience recurrent triggering dreams since any of your traumas? | B | The presence of intrusion symptoms such as recurrent distressing dreams involving the content of the dream related to the traumatic event is a noted diagnostic criterion for PTSD as per the DSM-5. Frequent, unpleasant memories are not a noted criteria for PTSD, nor is the feeling or urge to share about traumatic experiences. While these may be symptoms alerting to a psychologically distressing event or difficulty in achieving emotional resolution, they would not in and of themselves qualify for indications of PTSD. Traumatic brain injuries (TBI) are diagnosed separately from PTSD, therefore asking about TBI does not help rule out PTSD. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,059 | Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed. | First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, "I keep hurting him. One day I love him, and the next day I can't look at him." She pauses and asks, "What if he leaves me? I can't deal with that." She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness. The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others. She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life. The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress. Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, "He. Left. Me." You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce. The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, "I might as well give up. There's no point anymore." You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment. | The client's father died when she was very young. She describes her mother as having a "difficult time raising me and my brother as a single mother." The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern. | As a mandated reporter, who is the most appropriate person for you to contact regarding the client's depressive state? | The client's husband | Your supervisor | The client's psychiatrist | The client's mother | (A): The client's husband
(B): Your supervisor
(C): The client's psychiatrist
(D): The client's mother | The client's mother | D | The client's mother is the safest choice as the client's husband has left the family. The client listed her mother as an emergency contact on the intake form. Therefore, the correct answer is (B) | professional practice and ethics |
1,060 | Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency | The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner. | First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, "I can't believe this is happening at my age. I am all alone. What am I going to do?" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, "I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing." She describes having mixed feelings of anger, sadness, fear, and confusion. She states, "There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming." She further discloses that she is worried about having panic attacks again because "that's what happened the last time something of this magnitude happened to me." You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change. Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills. During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with "the other woman." She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what "normal" means to her. She says, "I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage." You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, "I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead." You reassure her that you are here to support her as she works through all of her difficult emotions. Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, "On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life." The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, "Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!" You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now. At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her. | null | As part of your yearly performance evaluation, you are asked to list examples of when you showed advocacy for client issues. Which of the following would be appropriate to include in your summary? | You provide therapeutic services at a reasonable cost for members of your community. | You were instrumental in procuring continued funding for a community senior center. | You have been the author of several well-received articles in a respected psychological journal. | You provided a free workshop about the importance of the counseling profession. | (A): You provide therapeutic services at a reasonable cost for members of your community.
(B): You were instrumental in procuring continued funding for a community senior center.
(C): You have been the author of several well-received articles in a respected psychological journal.
(D): You provided a free workshop about the importance of the counseling profession. | You were instrumental in procuring continued funding for a community senior center. | B | A facility that helps seniors is a client issue, and procuring continued funding for the community senior center demonstrates advocacy for clients on your part. Therefore, the correct answer is (D) | professional practice and ethics |
1,061 | Initial Intake: Age: 23 Gender: Male Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma. | Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents. | Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.” | Which of the following approaches is likely to be most effective for Shawn? | Creating pros and cons lists for hanging out with his friends | Asking challenging questions for Shawn to debate | Listing positive qualities and past successes for motivation | Pointing out Shawn's cognitive distortions to help increase insight | (A): Creating pros and cons lists for hanging out with his friends
(B): Asking challenging questions for Shawn to debate
(C): Listing positive qualities and past successes for motivation
(D): Pointing out Shawn's cognitive distortions to help increase insight | Listing positive qualities and past successes for motivation | C | Conducting this exercise will most likely improve Shawn's self-esteem, which is quite low. Approaches in answers a and b are quite confrontational and may only increase Shawn's sensitivity to his perceived criticism from his parents. Answer d might seem like a helpful intervention, however, pointing out anything negative that Shawn is already struggling with might only increase his anxiety and hyper focus on his existing resistance to spend time with his friends. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,062 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital. | The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling | Which concept would a gestalt therapist use to explain the client’s tendency to blame his parents for his current situation? | Introjection | Projection | Retroflection | Confluence | (A): Introjection
(B): Projection
(C): Retroflection
(D): Confluence | Projection | B | Gestalt therapists would use the concept of projection to explain the client’s interaction with his parents. Projection is the tendency to discount one’s role in an event and instead assign blame to others. Projection is common among individuals who, like the client, exhibit paranoia and suspicion. Introjection is the opposite of projection in that blame is assigned to oneself rather than the environment. Introjection involves psychologically swallowing information in the environment without proper analysis, judgment, or discernment. Introjection consists of doing what others would like one to do. Retroflection, which is translated into “turning back sharply against,” is doing to oneself what one would do to others. Lastly, confluence occurs when there is no delineation between self and others. Confluence can manifest into resentment and intolerance of oneself and others. Therefore, the correct answer is (A) | counseling skills and interventions |
1,063 | Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital | null | Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!” | null | When a counselor encounters clinical issues that he is not familiar with, he should? | Hope for the best | Conduct internet research | Refer out to another therapist | Consult with supervisor/colleagues | (A): Hope for the best
(B): Conduct internet research
(C): Refer out to another therapist
(D): Consult with supervisor/colleagues | Consult with supervisor/colleagues | D | It is not uncommon for counselors to encounter clinical issues that they are not familiar with. Other licensed clinicians, especially one's supervisor can help to inform/train counselors. Referral out should only be chosen if it is determined that the counselor does not have the capacity to work with the client and shouldn't be a first option. Being hopeful that positive changes can occur is an important trait for a counselor, but they should not just hope that they will gain the knowledge they need. This would be to the detriment to the client. Only professional or peer reviewed research should be conducted in this situation. Therefore, the correct answer is (C) | professional practice and ethics |
1,064 | Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent. | First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that "life has no meaning." She is seeking your help to find some relief. You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery. Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history. | The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities. | Which assessment would provide additional information related to the client's presenting problems? | World Health Organization Disability Schedule 2.0 | Hamilton Anxiety Rating Scale (HAM-A) | The client's substance use | Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale | (A): World Health Organization Disability Schedule 2.0
(B): Hamilton Anxiety Rating Scale (HAM-A)
(C): The client's substance use
(D): Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale | Hamilton Anxiety Rating Scale (HAM-A) | B | Given the client's diagnosis and presenting symptoms, this would be appropriate. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,065 | Initial Intake: Age: 45 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual | During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
| Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work. | null | An appropriate response from the counselor to Li's situation would be? | How much can you pay? | We must use your name for our records. | We can use a pseudo name if that is what you are most comfortable with. | Don't worry, if we use your real name, nothing will happen. | (A): How much can you pay?
(B): We must use your name for our records.
(C): We can use a pseudo name if that is what you are most comfortable with.
(D): Don't worry, if we use your real name, nothing will happen. | We can use a pseudo name if that is what you are most comfortable with. | C | There may be times when a client may not want to use their real name. If they are not paying through insurance, this should be accommodated. A client should not be forced to use their legal name. In this instance the client is concerned because they are not documented. It would be misleading to tell client to not worry and that nothing would happen to them. Asking about payment is not addressing the client's question and is insensitive to what the client is expressing. Therefore, the correct answer is (C) | counseling skills and interventions |
1,066 | Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency | Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age. | First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become "a nuisance for his babysitter, especially during bedtime." Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that "something bad will happen" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious. You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is "boring." However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines "all the ways they could be hurt" while they are not with him. You say, "I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better." You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions. Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself. When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress. Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, "My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious. At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week. | Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. | What immediate step(s) should you take in response to the loss of your notes? | You should only contact the client to report the incident. | You should report the loss to the insurance company covering the sessions. | You should contact your supervisor and your client to explain the potential breach of confidentiality. | You should only contact the supervisor to report the incident. | (A): You should only contact the client to report the incident.
(B): You should report the loss to the insurance company covering the sessions.
(C): You should contact your supervisor and your client to explain the potential breach of confidentiality.
(D): You should only contact the supervisor to report the incident. | You should contact your supervisor and your client to explain the potential breach of confidentiality. | C | This is the best answer as any breach of confidentiality, including your notes being thrown away in the trash, should be reported to both the client and your supervisor. Therefore, the correct answer is (C) | professional practice and ethics |
1,067 | Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual | John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.” | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners. | Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment. | Several weeks later, John calls you to share that he has reconnected with his daughter and is very grateful for your help. He offers to take you out to dinner with him and his daughter Friday night as a personal thank you. Which is the best response that is both ethical and supportive? | "I am not allowed to have social engagements with clients, it is inappropriate, I'm sorry." | "That's great news John! I cannot accept your invitation but thank you for offering!" | "That's great news John! I wouldn't be able to stay for long, but I can pop in to say hi." | "I am so happy for you both, but I have a prior engagement so it will have to be a raincheck." | (A): "I am not allowed to have social engagements with clients, it is inappropriate, I'm sorry."
(B): "That's great news John! I cannot accept your invitation but thank you for offering!"
(C): "That's great news John! I wouldn't be able to stay for long, but I can pop in to say hi."
(D): "I am so happy for you both, but I have a prior engagement so it will have to be a raincheck." | "That's great news John! I cannot accept your invitation but thank you for offering!" | B | This is the most straight forward response while also offering enthusiasm and support in celebrating your client's victory. Any other option suggests either that another social opportunity might be appropriate, or that you are more concerned with the ethics of the dinner invitation rather than the client's breakthrough news. Therefore, the correct answer is (D) | professional practice and ethics |
1,068 | Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual | The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror. | You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day. | Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft. | Which of the following interventions would be the most effective for beginning the termination? | Summarize the gains the client has made during the past six weeks | Use self-disclosure to share your disappointment at not continuing to work with the client | Ask the client if she enjoyed the clinician who visited her recently | Tell the client and her mother that this will be your last session together | (A): Summarize the gains the client has made during the past six weeks
(B): Use self-disclosure to share your disappointment at not continuing to work with the client
(C): Ask the client if she enjoyed the clinician who visited her recently
(D): Tell the client and her mother that this will be your last session together | Summarize the gains the client has made during the past six weeks | A | Summarizing the gains made by the client is the most effective way of beginning the termination. This allows the counselor, client, and her mother to see the improvements that they have made in the client and in the family. This focuses the improvement on the client and family rather than on the skill or contributions of the clinician. During the conversation that follows, each of the other responses will be appropriate but the conversation should not lead with these. Leading with self-disclosure focuses on the counselor and your feelings, not the client. It also does not tell the client or her mother what is happening. Telling the client and her mother that this is the last session is appropriate but is an abrupt statement that will cause distress while explanations are made and further information is given. Asking the client if she enjoyed the recent clinician is a good way to transition into discussing who will be providing services in the future, but still leaves the termination of the current relationship undisclosed. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,069 | Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss | First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a "bad group of kids." The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying. The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no "real" friends, and hates her life. The client sighs heavily, saying, "Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is "stuck in a dark hole" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings. After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week. Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has "no say" in what happens to her. She says that she wants to start attending a virtual school, but her mother "forced" her back to a physical school. The client says, "I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak." You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them. You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving. Seventh session It has been almost two months since you began therapy with the client. You suggested a session in which both she and her mother were present to discuss the client's progress. She presents to today's session with her mother. The client followed up with your referral from a previous session for her to see a psychiatrist and has provided you with a release of information to communicate with her psychiatrist. The client has been prescribed an antidepressant and says she does not feel any notable change yet but the psychiatrist told her it would take a few weeks to know if the medication was working. The mother states that since her daughter started taking the antidepressant, she is sleeping more than usual and struggles to get out of bed. She has been late to school several times. She is also having trouble with motivation. You reflect the client's current state and suggest she establish a daily routine to gain a sense of control in her life. You discuss the importance of making small achievable goals and explain that taking on too much can be overwhelming, so it is more beneficial to focus on one task at a time. The mother begins listing off potential activities that her daughter should take part in. The client closes her eyes and begins to sigh. When you ask her about her reaction, she says, "See, yet another example of my mom trying to control everything." The mother responds by saying, "I'm not trying to control you. Believe it or not, I just want what's best for you!" Understanding the tension between them, you suggest a compromise. You explain that if the client completes one activity each day, her mother will not pressure her to do more. The client appears hesitant but agrees to try it out. You then turn to the mother, thanking her for being willing to compromise and understanding. You encourage them to be patient with one another and remind them that progress takes time. You suggest they continue to have regular check-ins so that each party is aware of how the other is doing in following through on the agreement. You end the session by summarizing what was discussed, reinforcing the importance of communication between the client and her mother. | The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. | What post-test measure would best determine the effectiveness of your treatment? | Thematic Apperception Test | Outcome Rating Scale (ORS) | Problem-Oriented Screening Instrument for Teenagers | Beck Depression Inventory | (A): Thematic Apperception Test
(B): Outcome Rating Scale (ORS)
(C): Problem-Oriented Screening Instrument for Teenagers
(D): Beck Depression Inventory | Outcome Rating Scale (ORS) | B | The ORS is a brief outcome measure which enables clients to provide feedback on their perceptions of their progress in achieving their therapeutic goals. Therefore, the correct answer is (D) | treatment planning |
1,070 | Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center | The client looks anxious and uneasy, presenting with a "nervous" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted. | First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling. He continues by telling you, "I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't." The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed. | The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from "under the thumb" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a "loser" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. | Which of the following is considered a differential diagnosis for Social Anxiety Disorder? | Agoraphobia | Antisocial Personality Disorder | Paranoid Personality Disorder | Borderline Personality Disorder | (A): Agoraphobia
(B): Antisocial Personality Disorder
(C): Paranoid Personality Disorder
(D): Borderline Personality Disorder | Agoraphobia | A | Agoraphobia is a differential for Social Anxiety Disorder. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,071 | Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3) | Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio | You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English. | n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family. The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality | The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality. This describes which of the following culturally bound conditions? | Ataque de nervios | Mal de ojo | Susto | Confianza | (A): Ataque de nervios
(B): Mal de ojo
(C): Susto
(D): Confianza | Susto | C | Susto, in particular interpersonalsusto, is characterized by feelings of abandonment, loss, sadness, suicidality, and poor self-worth. According to the DSM-5-TR, “Sustois an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness, as well as difficulties functioning in key social roles” (APA, 2022). The DSM-5-TR describes syndromic types to include interpersonalsusto, sustorelating to a traumatic event, andsustomarked by somatic symptomsAtaque de nervios(ie, “attack of nerves”) is an idiomatic expression used by Latinos to describe symptoms of intense anger, grief, worry, dissociation, or emotional distressAtaque de nervioscan escalate to the point of uncontrollable crying, seizures, shaking, and verbal or physical aggression. These attacks can occur as the result of a stressful event (eg, news of the death of a significant person, familial conflict) but can also happen in the absence of a stressful event or trigger for a minority of individualsConfianza is a Hispanic value that refers to the sense of comfort and ease when revealing oneself to another. For Hispanics, establishing trust within the confines of the therapeutic relationship can promote healing and restore ties within the context of personal relationships. Finally,mal de ojo,a Spanish term meaning “evil eye,” is associated with social conflict or jealousy and is believed to cause physical illness, misfortune, and death. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,072 | Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3) | Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio | You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English. | The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community. You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness | You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness. According to Beck, causes of the client’s distorted thinking can be attributed to which of the following? | Feelings of inferiority due to a mistaken style of life | Activating events, beliefs, and consequences | Unresolved unconscious conflicts | View of oneself, the world, and one’s future | (A): Feelings of inferiority due to a mistaken style of life
(B): Activating events, beliefs, and consequences
(C): Unresolved unconscious conflicts
(D): View of oneself, the world, and one’s future | View of oneself, the world, and one’s future | D | Beck would attribute causes of the client’s distorted thinking to their view of themselves, their world, and their future. These cognitive deficiencies are known as the “cognitive triad” Freud attributed maladaptive behavior to unresolved conscious conflicts. Adlerian therapists view maladjustment as the development of a mistaken style of life leading to feelings of inferiority. Known for rational-emotive therapy, Ellis suggests that irrational thinking can be deconstructed by recognizing an activating event, beliefs, and consequences. Therefore, the correct answer is (D) | counseling skills and interventions |
1,073 | Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School | The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment. | First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read. You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: "Let's try incorporating creative activities as part of our therapy sessions." Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter." The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises. Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable. You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times. After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client. Ninth session The client's parents were elated to see their daughter make significant progress in her reading at school. After careful consideration and collaboration between you, the client, her teachers, and the paraprofessional, the team has all devised a treatment plan tailored specifically to her needs. Incorporating a small group setting provided the client with the individualized attention she needed to become successful in her reading skills. As the session came to an end today, it was clear that both the client and her parents were satisfied with the results of their hard work. To ensure that they felt comfortable moving forward and everybody was on the same page, you asked them, "What I hear you saying is that you feel as though your daughter has met her educational goals and has the support to continue to succeed? Is that correct?" Both of them smiled knowingly and nodded affirmatively. With a sense of closure now achieved by this family team, the parents left feeling confident about continuing on this path towards helping their daughter reach success with reading deficits. Together they had created a practical plan which could be adapted as necessary along the way, one which would pave a brighter future for the client. | The client says she is only poor at reading and "good at everything else." She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is "stupid" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. | What resource would you recommend for continued support after termination? | Family Therapy | Peer Support Group for behavioral issues | Organization for families of children with learning disabilities | Medication referral for anxiety | (A): Family Therapy
(B): Peer Support Group for behavioral issues
(C): Organization for families of children with learning disabilities
(D): Medication referral for anxiety | Organization for families of children with learning disabilities | C | The parents and client will benefit from connecting with others in their community (whether it's in person or an online community) who are dealing with similar issues. Therefore, the correct answer is (B) | treatment planning |
1,074 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital. | The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals. The client blames his parents for his problems. You ask the client to add the phrase “… and I take responsibility for it” at the end of his statements to create present-moment awareness and help him assume responsibility for his current difficulties | The client blames his parents for his problems. You ask the client to add the phrase “… and I take responsibility for it” at the end of his statements to create present-moment awareness and help him assume responsibility for his current difficulties. This is a technique of which one of the following? | Acceptance and commitment therapy (ACT) | MI | Transactional analysis | Gestalt therapy | (A): Acceptance and commitment therapy (ACT)
(B): MI
(C): Transactional analysis
(D): Gestalt therapy | Gestalt therapy | D | Gestalt therapists use the technique of adding, “… and I take responsibility for it” at the end of client statements. Gestalt therapy is centered in the present moment and is designed to raise awareness of blocks to self-growth through the promotion of personal responsibility. Transactional analysis therapists use parent, adult, and child ego states to represent patterns of thinking, feeling, and acting. Techniques for transactional analysis include game and script analysis. ACT combines mindfulness and behavioral therapy to assist individuals with greater self-acceptance of uncomfortable feelings. ACT techniques include cognitive diffusion and creating a life compass. Finally, MI is a counseling approach that uses multiple strategies to evoke change, including developing discrepancy and rolling with resistance. Therefore, the correct answer is (A) | counseling skills and interventions |
1,075 | Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses | You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment. | Sixth Session, 3 Weeks After the Initial Intake The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness | Which one of the following best defines acceptance and commitment therapy? | Notice and embrace the situation at hand. | Focus on human abilities and limitations. | Accept the situation and realize one’s ability to change thoughts and behaviors for a different outcome. | Focus on releasing repressed emotions and experiences. | (A): Notice and embrace the situation at hand.
(B): Focus on human abilities and limitations.
(C): Accept the situation and realize one’s ability to change thoughts and behaviors for a different outcome.
(D): Focus on releasing repressed emotions and experiences. | Notice and embrace the situation at hand. | A | Acceptance and commitment therapy focuses on accepting present emotions and staying present in those thoughts and emotions without judgment. Accepting the situation and realizing the ability to change it is a CBT approach. The focus on human abilities and limitations is key to existential therapy. A focus on repressed emotions and experiences is a feature of psychoanalysis. Therefore, the correct answer is (A) | counseling skills and interventions |
1,076 | Initial Intake: Age: 4 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual | Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session. | Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.
History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case. | null | What historical data is important to gather currently? | Early family history | Immunization records | Seasonal mood patterns | Quality of Darlene and Tony's relationship | (A): Early family history
(B): Immunization records
(C): Seasonal mood patterns
(D): Quality of Darlene and Tony's relationship | Early family history | A | Destiny's early family history may fill in some important pieces of information such as attachment with early caregiving figures. Although health information is needed, immunization records are not needed. There are no patterns to Destiny's behaviors so there is no need to track seasonal mood patterns. Currently, there is no information to suggest that Darlene and Tony are having conflict. If there was some indication, it would important information to review as Destiny has lost parental figures in the past. Therefore, the correct answer is (A) | professional practice and ethics |
1,077 | Initial Intake: Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual | The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. | You are a counselor in a community agency that provides counseling. Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help. She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.” | Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions. | Which of the following should you discuss with the client in preparation for counseling? | Counseling is only effective when the client feels safe enough to be themselves. | Counseling is hard work and sometimes she will leave feeling emotionally tired. | Counseling works best if the client commits to weekly sessions in the first few months. | Counseling only works if the client is completely truthful with the counselor. | (A): Counseling is only effective when the client feels safe enough to be themselves.
(B): Counseling is hard work and sometimes she will leave feeling emotionally tired.
(C): Counseling works best if the client commits to weekly sessions in the first few months.
(D): Counseling only works if the client is completely truthful with the counselor. | Counseling is only effective when the client feels safe enough to be themselves. | A | Research has shown that the therapeutic relationship between client and counselor is the most important element in effective counseling. When the client feels safe enough to be themselves, they will, in the therapy room, act in the same ways that they interact with others, which allows the counselor to help them look at their interpersonal style and skills. As a result, the client can choose new ways to think, feel, and behave. It is true that counseling is hard, clients will sometimes leave tired, and counseling can move faster if clients attend weekly at first. The latter is not a requirement for effective counseling however and slower gains are still beneficial. Counseling is easier and may work more effectively if a client is truthful with the counselor but it is not necessary. Clients may tell their stories from a skewed perspective and the truth they tell may not be what actually occurred. Counselors are trained to observe clients and through empathic attunement and responses may help clients work on ways of thinking, feeling, and behaving without knowing the full circumstances about an event. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,078 | Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center | The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety. | First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, "About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it." She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack. She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, "I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense." As she wipes tears from her eyes, she shares, "I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband." She tells you that she had a "bad experience" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never "get better." She also states she feels like a "bad wife and mother" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her. | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal. The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. | Based on the client's history and self-report during the initial session regarding her symptoms and behavior, which diagnosis would you consider? | Social Anxiety Disorder | Avoidant Personality Disorder | Panic Disorder and Agoraphobia | Panic Disorder | (A): Social Anxiety Disorder
(B): Avoidant Personality Disorder
(C): Panic Disorder and Agoraphobia
(D): Panic Disorder | Panic Disorder and Agoraphobia | C | The client meets criteria for both Panic Disorder and Agoraphobia. She has reported having multiple panic attacks which are sudden episodes of intense fear or discomfort that peak within minutes, along with Agoraphobia which is an intense fear and avoidance of situations in which escape may be difficult or embarrassing. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,079 | Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency | The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner. | First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, "I can't believe this is happening at my age. I am all alone. What am I going to do?" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, "I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing." She describes having mixed feelings of anger, sadness, fear, and confusion. She states, "There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming." She further discloses that she is worried about having panic attacks again because "that's what happened the last time something of this magnitude happened to me." You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change. Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills. During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with "the other woman." She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what "normal" means to her. She says, "I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage." You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, "I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead." You reassure her that you are here to support her as she works through all of her difficult emotions. Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, "On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life." The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, "Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!" You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now. At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her. | null | Which of the following counseling skills did you demonstrate in this session? | Interpretation | Active listening | Reflection of meaning | Rationalization | (A): Interpretation
(B): Active listening
(C): Reflection of meaning
(D): Rationalization | Active listening | B | You used active listening to help the client in this session. This is evidenced by you validating the client's feelings, offering reassurance, and providing helpful tips. Therefore, the correct answer is (B) | counseling skills and interventions |
1,080 | Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation. | First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is "at her wit's end" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude. Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents. Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are "mean" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like "The Flash, the superhero who is the fastest human on Earth." You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age. You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits. You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others. Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, "I feel like my parents don't care about me." You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will "side with" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife. You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical. In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents. | The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, "tries to get along" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away. | What would be the best structured activity to facilitate the client in expressing how he feels without confronting anyone? | Family system's approach with subsystems | Virginia Satir's family sculpting technique | Minuchin's joining technique | Whitaker's multi-family group | (A): Family system's approach with subsystems
(B): Virginia Satir's family sculpting technique
(C): Minuchin's joining technique
(D): Whitaker's multi-family group | Virginia Satir's family sculpting technique | B | This is a technique in family therapy and is will likely be the most helpful for the client. The therapist asks one or more family members to arrange the other members (and lastly themselves) in relation to one another in terms of posture, space, and attitude to portray the arranger's perception of the family. Therefore, the correct answer is (A) | counseling skills and interventions |
1,081 | Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3) | Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua | You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member. | rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives | Which of the following would be an appropriate short-term goal for the first month of the weekly therapy sessions? | Identify the ways in which borderline personality disorder affects the individuals’ relationships. | Reduce client urges to engage in self-harming behavior. | Improve the relationship quality with people of importance to the individuals. | Improve communication skills with people of importance to the individuals. | (A): Identify the ways in which borderline personality disorder affects the individuals’ relationships.
(B): Reduce client urges to engage in self-harming behavior.
(C): Improve the relationship quality with people of importance to the individuals.
(D): Improve communication skills with people of importance to the individuals. | Identify the ways in which borderline personality disorder affects the individuals’ relationships. | A | The first step will be assisting the clients with acknowledging that they have borderline personality disorder and understanding how it affects their life because this diagnosis can be difficult for an individual to accept. Improving relationship quality, reducing urges to self-harm, and improving communication will likely take more than a month to initiate and achieve. These goals will require you to first establish a secure relationship with the group, in order for them to feel comfortable enough to explore the required complexities of their condition and its impact on relationships and feelings toward themselves. Therefore, the correct answer is (A) | treatment planning |
1,082 | Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School | The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease. | First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to "drift off and is fidgety." He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling. After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, "It's okay." You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because "there are too many things happening at the same time." He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk. Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods. Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance. The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they "move too fast," and he cannot keep up. The client says he does not feel it is fair that "the teacher yells at me every day even when I'm trying my best." He says, "She's mean, and I won't go back to her class ever again!" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer. In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher. | The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. | What strategy would be most effective for the client to use to cope with feeling overwhelmed in math class? | Verbalizing negative thoughts about the teacher | Asking questions in class to clarify instructions | Suggesting more practice with extra math assignments at home | Taking regular breaks between short periods of focused work | (A): Verbalizing negative thoughts about the teacher
(B): Asking questions in class to clarify instructions
(C): Suggesting more practice with extra math assignments at home
(D): Taking regular breaks between short periods of focused work | Taking regular breaks between short periods of focused work | D | Taking regular breaks to regroup and refocus can help the client to better manage the stress and anxiety associated with feeling overwhelmed in a math class. This strategy allows the client to step away from the situation and take a few moments to refocus on the task at hand. Therefore, the correct answer is (D) | treatment planning |
1,083 | Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5) | Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam | You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns. | The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client | Which cognitive distortion operates from the premise that his wife’s refusal to conform to the client’s high standards is associated with ineptitude and defiance? | Personalization | Mind reading | Overgeneralization | Black and white thinking | (A): Personalization
(B): Mind reading
(C): Overgeneralization
(D): Black and white thinking | Black and white thinking | D | Black and white thinking is the cognitive distortion associated with the belief that anyone who refuses to conform to the client’s standards is seen as inept and defiant. Black and white thinking, also known as polarization or all or nothing thinking, is exhibited when shades of gray are not acknowledged. There is ridged inflexibility with others. If the wife agrees and conforms to the client’s perfectionistic standards, all is well in the relationship. If the wife dissents and refuses to comply with the client’s perfectionistic standards, she is inept and defiant. Something is either great or terrible; a person is either perfect or a failure. Overgeneralization, personalization, and mind-reading, generally result in self-blame, which is atypical for individuals with OCPD. Overgeneralization occurs when broad implications are based on one or two minor instances (eg, “I let down a friend. Now everyone thinks I’m a total disaster!”). Personalization happens when one assigns themselves blame without solid logistical evidence. As the name implies, mind-reading occurs when one jumps to conclusions or negatively interprets another person’s intentions, feelings, and actions. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,084 | Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth | The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor. | First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to "go in a different direction." She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, "We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem." As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support. As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are "no more than hired help." You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you. You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as "competition." Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood. You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, "I'm an actress and have auditions. How long is this going to take?" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week. | The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures. Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress. Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling "distraught" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience. The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem. | Why is it essential to assess for trauma when considering the client's provisional diagnosis and the potential influence of past traumatic experiences on her current psychological presentation and implications for your treatment plan? | Trauma will lead to Borderline Personality Disorder symptoms, including emotional dysregulation. | A trauma assessment should be carried out as the client is mandated to therapy by the court. | High risk-taking in Borderline Personality Disorder leads to trauma. | Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity. | (A): Trauma will lead to Borderline Personality Disorder symptoms, including emotional dysregulation.
(B): A trauma assessment should be carried out as the client is mandated to therapy by the court.
(C): High risk-taking in Borderline Personality Disorder leads to trauma.
(D): Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity. | Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity. | D | BPD and PTSD often do have high comorbidity with one another. Because of this correlation, assessing for trauma may reveal other pathologies that must be addressed in your treatment plan. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,085 | Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual | Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.” | Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids. | Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice. | How would you motivate Raul to elaborate on his perspectives? | Direct him to share more about how he got in trouble at school | Pretend you agree with him to improve rapport | Completely disagree with him in hopes he argues his positions more | Ask him to explain further because you do not understand | (A): Direct him to share more about how he got in trouble at school
(B): Pretend you agree with him to improve rapport
(C): Completely disagree with him in hopes he argues his positions more
(D): Ask him to explain further because you do not understand | Ask him to explain further because you do not understand | D | Using this direct method of asking him to explain more to help you understand him is the best choice here. Feigning agreement or disagreement as tactics to get him to elaborate will not necessarily work as they may either unethically guide him towards thinking his perspectives are "correct" (while there should be no right or wrong answer) or make him feel alienated and judged by his counselor arguing with him. Directing him to tell you about his mistakes made in school in the middle of this exercise might cause Raul to shut down and not further participate in future exercises because of feeling like they are a "trap" or segue into sharing about himself. You can still be effective in providing Raul support during this conversation, even if Raul does not admit to his own feelings or experiences. Projecting his feelings and experiences to hypothetical scenarios may give you enough information for you to better understand him. Therefore, the correct answer is (C) | counseling skills and interventions |
1,086 | Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic | The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting. | First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is "down in the dumps" most of the time. When asked why he left the Navy, he replies: "Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day." Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore." Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD. The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later. The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds. Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms. | The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest. During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis. The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine. | What empathetic response would be the most effective in addressing the client's concern? | "I hear you when you say you are ready to look for work, do you really think you are prepared for that?" | It appears that you are prepared to start working but have some concerns. I recommend proceeding with it promptly. | I have complete confidence in your readiness for work. Let's focus on the task at hand and assist you in finding a job. | "It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action." | (A): "I hear you when you say you are ready to look for work, do you really think you are prepared for that?"
(B): It appears that you are prepared to start working but have some concerns. I recommend proceeding with it promptly.
(C): I have complete confidence in your readiness for work. Let's focus on the task at hand and assist you in finding a job.
(D): "It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action." | "It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action." | D | This response reflects the client's concerns back at him while still allowing for the progression of therapy with the client's permission. Therefore, the correct answer is (B) | counseling skills and interventions |
1,087 | Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual | Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin. | Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers. | null | Possible short-term goals may include? | Engage in family counseling with father | Identify stressors which precipitated event | Taking antipsychotic medication on his own without reminders | Implement an effective crisis plan | (A): Engage in family counseling with father
(B): Identify stressors which precipitated event
(C): Taking antipsychotic medication on his own without reminders
(D): Implement an effective crisis plan | Identify stressors which precipitated event | B | Short term goals are important because they are usually attainable and can build confidence in completing long term goals. A short-term goal may be for Mark to identify stressors that happen prior to an event. Mark may have difficulty taking medication on his own, without reminders, so this may be a long-term goal. Also, before implementing an effective treatment plan, the plan must be created first. Marc's father reaching out to him was a contributing factor to the stress Mark was facing prior to his first psychotic episode. Since Mark's father seems to be a trigger for him, this would be a long-term goal, if it is a priority for Mark. Therefore, the correct answer is (B) | treatment planning |
1,088 | Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual | The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress. Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm. | You are a counselor in a community mental health agency setting. Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.” He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off. | Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth. | Based on the information gained in the intake, which of the following goals will be primary? | Client will experience no suicidal ideation or thoughts of self-harm | Client will obtain employment to meet his needs for independence | Client will develop a support system to meet his needs for community and support | Client will experience reduction in depression and anxiety | (A): Client will experience no suicidal ideation or thoughts of self-harm
(B): Client will obtain employment to meet his needs for independence
(C): Client will develop a support system to meet his needs for community and support
(D): Client will experience reduction in depression and anxiety | Client will experience no suicidal ideation or thoughts of self-harm | A | Each of the choices are excellent goals for the client described, however safety is always the priority goal. Because the client has a history of suicidal ideation with a plan, this is the goal that must be addressed first. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,089 | Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School | The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment. | First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read. You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: "Let's try incorporating creative activities as part of our therapy sessions." Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter." The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises. | The client says she is only poor at reading and "good at everything else." She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is "stupid" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. | Besides a learning disability, what would you identify as an area of clinical concern? | Mathematical capabilities | Sleep patterns | Medical history | Lack of parental involvement | (A): Mathematical capabilities
(B): Sleep patterns
(C): Medical history
(D): Lack of parental involvement | Medical history | C | The client's medical history would be indicated as an area of clinical concern due to her seizures. If the client has a seizure in session, it is important to discuss with the parents what should be done to ensure her safety. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,090 | Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation. | First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is "at her wit's end" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude. Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents. Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are "mean" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like "The Flash, the superhero who is the fastest human on Earth." You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age. You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits. You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others. | The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, "tries to get along" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away. | Why would you tell the client that you believed you were a superhero when you were his age? | To promote the use of rationalization | To build the therapeutic relationship | To encourage reaction formation | To demonstrate positive self-regard | (A): To promote the use of rationalization
(B): To build the therapeutic relationship
(C): To encourage reaction formation
(D): To demonstrate positive self-regard | To build the therapeutic relationship | B | It can be valuable to self disclose personal information to build the therapeutic relationship. Many clients feel uneasy telling a stranger about their thoughts, feelings, and experiences. Getting to know their therapists better on a personal level can help ease this feeling. Self-disclosure on the therapist's part can be used to express empathy and help these clients feel that their emotions and experiences are being validated. During the intake, you noted that the client was wearing a DC Comic shirt, and he also expressed an interest in a superhero. Therefore, the correct answer is (D) | counseling skills and interventions |
1,091 | Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation. He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else. | You are a counselor in a private practice setting. Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.” | Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.” He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly. | Based on the information provided, which of the following should the counselor ask about to narrow down the suspected diagnosis? | Fear and anxiety in social situations that he will be humiliated, embarrassed, and rejected | Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event | Developmentally inappropriate and excessive fear or anxiety being separated from others | Severe recurrent temper outbursts, out of proportion with the situation, before the event | (A): Fear and anxiety in social situations that he will be humiliated, embarrassed, and rejected
(B): Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event
(C): Developmentally inappropriate and excessive fear or anxiety being separated from others
(D): Severe recurrent temper outbursts, out of proportion with the situation, before the event | Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event | B | As PTSD is the suspected diagnosis, it would be important to ascertain whether the client meets the required criteria, one of which is Criterion B, the presence of intrusion symptoms associated with and beginning after the traumatic event. These can include memories, dreams, flashbacks, or exposure cues that trigger intense distress. Fear and anxiety in social situations with the potential of rejection is a required criterion of social anxiety disorder and is not apparent in this client's information. Temper outbursts that are out of proportion with the situation appear as described by the client but he states they began after his father's death, not before. This is a required criteria for disruptive mood dysregulation disorder, which must begin before age 10. The client states that prior to his father's death, he did not experience angry outbursts. Developmentally inappropriate and excessive fear or anxiety at separation from others is a required criterion for separation anxiety, which can occur in children and adults following a trauma; however, the client lives at a distance from his family but provides no indication of anxiety or fear related to separation from them. Therefore, the correct answer is (B) | counseling skills and interventions |
1,092 | Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement. | You are a counselor in a private practice setting. During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships. He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements. | Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it. | Based on the information gained in the intake, what diagnoses are most appropriate to consider for this client? | Schizoid personality disorder; Alcohol use disorder | Alcohol use disorder; Paranoid personality disorder | Alcohol use disorder; Adjustment disorder | Major depressive disorder; Alcohol use disorder | (A): Schizoid personality disorder; Alcohol use disorder
(B): Alcohol use disorder; Paranoid personality disorder
(C): Alcohol use disorder; Adjustment disorder
(D): Major depressive disorder; Alcohol use disorder | Major depressive disorder; Alcohol use disorder | D | The client's symptoms are most closely related to a depressive disorder (MDD) including sadness, crying, lack of energy, feelings of failure. While the client may not yet have expressed all the symptoms needed for the diagnosis, MDD should be investigated along with alcohol use disorder (AUD) based on the clients' concerns about his drinking. While the client endorses suspiciousness based on his spouse's activities, these are not irrational suspicions and do not indicate paranoid personality disorder. The client expresses strained relationships with many family members and restricted range of emotional expression, but does desire close relationships, does not appear indifferent to praise or criticism, and does not endorse "almost always choosing solitary activities". The client reports moving this year, which could point to an adjustment disorder, however his spouse indicated through the client's report that the problems have been longstanding. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,093 | Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency | The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could "disappear." | First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks "too much" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy. The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels. Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a "big fight" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, "I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family." He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues. In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change. | The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. | How would you reframe the client's negative statement of never being able to make enough money to support his family? | "You have found success in the past and I believe that you will do so in the future." | "Money isn't everything. You can still be a successful provider even if your finances are not where you want them to be." | “You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.” | "You need to make more money, but it's ok to take some time off to take care of yourself, too." | (A): "You have found success in the past and I believe that you will do so in the future."
(B): "Money isn't everything. You can still be a successful provider even if your finances are not where you want them to be."
(C): “You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.”
(D): "You need to make more money, but it's ok to take some time off to take care of yourself, too." | “You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.” | C | This statement helps the client to reframe his thinking in a more productive way. By acknowledging that he is doing his best and recognizing that he can take steps to improve his financial situation, he can move past the anxiety-inducing thought of never having enough money and focus on what actions he can take to make progress. This shift in perspective allows him to feel empowered to make a change, rather than feeling helplessly stuck or overwhelmed. It also reminds him that anxiety is something that can be managed with effort and practice. Therefore, the correct answer is (B) | counseling skills and interventions |
1,094 | Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual | The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene. Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else. | You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help. | Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town. | Based on the information provided, which of the following diagnoses would the counselor not suspect for this client? | Major Depressive Disorder (MDD) | Attention Deficit Disorder (ADHD) | Obsessive Compulsive Disorder (OCD) | Bipolar Disorder (BPD) | (A): Major Depressive Disorder (MDD)
(B): Attention Deficit Disorder (ADHD)
(C): Obsessive Compulsive Disorder (OCD)
(D): Bipolar Disorder (BPD) | Bipolar Disorder (BPD) | D | Hoarding disorders are often linked to OCD, OCPD, ADHD, Depression, and often begin after a traumatic experience. Bipolar I Disorder may be linked to clutter during manic phases, but is not generally associated with Hoarding disorder. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,095 | Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3) | Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea | You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library. | The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage | Brief Strategic Family Therapy (BSFT) uses which of the following? | Enactments and sculpting | Reframing and restructuring | Linking and pacing | Chaining and modeling | (A): Enactments and sculpting
(B): Reframing and restructuring
(C): Linking and pacing
(D): Chaining and modeling | Reframing and restructuring | B | Brief strategic family therapy (BSFT) uses reframing and restructuring after joining with the family and diagnosing the problem. BSFT is an evidence-based practice for ODD grounded in the here-and-now, emphasizes process over content, and includes techniques such as reframing and restructuring. Reframing, a form of restructuring, is used to help clients view situations, feelings, and relationships in a more positive light. Counselors use restructuring by instructing families to interact during the therapy session. This allows counselors to assess family dynamics (eg, boundaries and alliances) and restructure family systems by providing alternative ways for members to behave and communicate. Linking is a group leadership skill used to help members relate to one another’s challenges, solutions, and other shared experiences. Pacing occurs when counselors attend to the emotional intensity of a session. Brief strategic family therapists use enactments, while human validation process model family therapists use sculpting. Counselors use enactments by having family members talk to one another rather than the counselor. Enactments help illustrate relationship patterns and identify patterns and roles requiring modification. Sculpting is a non-verbal technique where the counselor physically arranges family members to help them envision aspects of emotional closeness or distance. Chaining, which refers to reinforcing the totality of a sequence of behaviors, is a behavioral therapy technique. Finally, modeling, which is necessary for imitation, is a component of social learning theory. Therefore, the correct answer is (B) | counseling skills and interventions |
1,096 | Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation. | First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is "at her wit's end" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude. Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents. Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are "mean" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like "The Flash, the superhero who is the fastest human on Earth." You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age. You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits. You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others. Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, "I feel like my parents don't care about me." You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will "side with" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife. You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical. In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents. | The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, "tries to get along" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away. | How would you reflect the client's feelings about his parents in the session? | "It makes sense to me that you would feel like your parents don't care about you because they don't seem very supportive of you being on the track team." | "I understand how you feel. There are times when I felt like my parents didn't care about me." | "It sounds like you are feeling unloved and unimportant to your parents right now." | "Thank you for sharing your thoughts with me. Can you tell me more about why you feel like your parents don't care about you?" | (A): "It makes sense to me that you would feel like your parents don't care about you because they don't seem very supportive of you being on the track team."
(B): "I understand how you feel. There are times when I felt like my parents didn't care about me."
(C): "It sounds like you are feeling unloved and unimportant to your parents right now."
(D): "Thank you for sharing your thoughts with me. Can you tell me more about why you feel like your parents don't care about you?" | "It sounds like you are feeling unloved and unimportant to your parents right now." | C | One way to think about reflecting feelings is to imagine that you are holding up a mirror to the person's emotions. You are not trying to change or fix the emotions, but simply acknowledging and reflecting back what you see and hear. This can be an incredibly powerful therapeutic tool, because it helps the person feel heard and understood. It also allows the person to see their emotions from a different perspective, which can be helpful in managing and coping with them. Therefore, the correct answer is (B) | counseling skills and interventions |
1,097 | Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0) | Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa | You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive. | The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening | When the husband is crying, all of the following are helpful techniques for the couple, EXCEPT: | Practicing immediacy | Supporting the husband in using coping skills | Redirecting to the wife with questions about her response to his crying | Allowing space for him to cry | (A): Practicing immediacy
(B): Supporting the husband in using coping skills
(C): Redirecting to the wife with questions about her response to his crying
(D): Allowing space for him to cry | Supporting the husband in using coping skills | B | Supporting the husband in using coping skills is the least helpful technique in this situation because the husband needs to feel safe expressing his raw emotions in the manner that comes most naturally to him. Otherwise, repression of these feelings may occur. Muting those feelings with trained coping skills detracts from an important element of processing because the husband and wife both need to experience their emotions surrounding their situation to better understand and express their viewpoints. Immediacy would be helpful because it involves directly addressing the presenting emotions and behavior. Allowing space for the husband to experience his emotions is helpful for the husband (as a releasing process) and also for the wife (to allow her to actively experience how her spouse is feeling). Redirecting to the wife may also be helpful because this may provide her with appropriate tools for responding to her husband’s emotions in a way that makes him feel supported and less isolated. Therefore, the correct answer is (D) | counseling skills and interventions |
1,098 | Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual | Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago. | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children. | Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.” | null | adult immaturity | ruminating | poor insight and judgment | PTSD | (A): adult immaturity
(B): ruminating
(C): poor insight and judgment
(D): PTSD | poor insight and judgment | C | Davone's lack of ability to identify cause and effect of his behaviors is a result of a defect in reflective functioning, otherwise known as having low insight and poor judgment or decision-making skills. These factors do present as immature for an individual of age 35, however answer a) is not a clinical term as the question requests. Repetitive arguing indicates rumination. PTSD, or post-traumatic stress disorder, can cause several problematic cognitive and emotional manifestations but also does not answer the question as much as it suggests a condition that he could be suffering from. Therefore, the correct answer is (D) | null |
1,099 | Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency | The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore. | First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been "critical of me even talking about moving her into an assisted living facility" and are pressuring her to keep their mother at home. The client starts to cry and covers her face. Finally, she looks up and says, "I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up." The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, "I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen." She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, "It's like history is just repeating itself." She reports feeling "like a failure at being a wife, mother, sister, and daughter." As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it. When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without "losing myself and my sanity in the process." You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy. | The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly "nags" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a "massive strain" on the couple's relationship. | You state, "It sounds like you are feeling conflicted about taking on the role of caregiver for your mother. Can you tell me more about your relationship with your mother and siblings?" What are you demonstrating with this response? | Exploration of problem | Unconditional positive regard | Non-judgmental stance | Simple restatement | (A): Exploration of problem
(B): Unconditional positive regard
(C): Non-judgmental stance
(D): Simple restatement | Exploration of problem | A | By asking the client to provide further information about her relationship with her mother and siblings, you are exploring the problem. Remember that the client seeks help to resolve inner conflict and address dysfunctional family dynamics. Therefore, the correct answer is (D) | counseling skills and interventions |
1,100 | Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility | The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor. | First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been "serious problems" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use "got out of control." Although he has been able to maintain sobriety for two years, he says that his wife is "paranoid" that he is using again and insists on knowing where he is "every minute of the day." He further reports that his wife is "too dependent" on him, and he feels "suffocated." He says, "I just can't keep doing this" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, "Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him." She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, "he just gets mad and leaves the room." Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again. Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, "That's not true!" and proceeds to tell you that she "caught" him holding a bottle of liquor in their garage this morning. The husband replies, "I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?" She replies, "I really want to believe you, but you make it really hard to do that." He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, "Fine. You know where to find me." The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words. You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to "make things right" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship. After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city. Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, "I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions. You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, "I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too." You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support. | The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father. | What would be the most appropriate referral for the wife? | Group therapy | Family therapy | Psychiatrist | Individual therapy | (A): Group therapy
(B): Family therapy
(C): Psychiatrist
(D): Individual therapy | Individual therapy | D | Individual therapy could provide the wife with a safe and confidential space to process her feelings of anxiety, fear, and helplessness around her husband's drinking. In individual therapy, the therapist could also assist in providing her with practical skills for coping, such as problem solving and stress management. Therefore, the correct answer is (C) | treatment planning |
Subsets and Splits