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1,201 | Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple | The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. | You are a counselor in a private practice setting. Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her. He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.” Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously. | Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure. | Which of the following interventions will be most beneficial to help the clients between sessions? | Sign a behavioral contract stating each will communicate with the other daily | Have the couple put communication lower on their priorities until John feels better | Identify accountability partners for the couple to ensure they are communicating | Collaboratively develop a list of topics the couple feel safe talking about | (A): Sign a behavioral contract stating each will communicate with the other daily
(B): Have the couple put communication lower on their priorities until John feels better
(C): Identify accountability partners for the couple to ensure they are communicating
(D): Collaboratively develop a list of topics the couple feel safe talking about | Collaboratively develop a list of topics the couple feel safe talking about | D | Collaboratively developing a list that both John and Jane feel safe talking about provides a safe space for communication without the worry that either must talk about hard topics such as infertility or divorce while the relationship is strained. Signing a behavioral contract and identifying accountability partners are likely to put more pressure on the couple during a time when the individuals and the relationship are fragile. Encouraging them not to communicate while John is attempting to manage his depression may increase Jane's feelings of anger or sadness. It may take several weeks for John's mood to begin lifting and discouraging them from working on communicating for that time is not helpful in rebuilding their relationship. Therefore, the correct answer is (B) | treatment planning |
1,202 | Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual | The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry. Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now. Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices. | You are a counselor in a community mental health agency. The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch. The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.” She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high. | Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.” | Based on the information gained from these three sessions, which intervention would be most effective in helping the client build insight related to her alcohol and substance use? | Have client attend a substance abuse therapy group | Complete a family genogram with information on substance use | Administer the Michigan Alcoholism Screening Test (MAST) | Gently challenge the client using her past history of substance use and outcomes | (A): Have client attend a substance abuse therapy group
(B): Complete a family genogram with information on substance use
(C): Administer the Michigan Alcoholism Screening Test (MAST)
(D): Gently challenge the client using her past history of substance use and outcomes | Have client attend a substance abuse therapy group | A | Clients with substance addiction are prone to denying the extent that their substance abuse causes themselves or others. Family genograms and MAST assessments may provide information about patterns of use, but are not likely to facilitate insight when a client is in denial. Challenging the client with their history brings attention to incongruities, but the addict's need for deniability is strong with addiction and the counselor, particularly when working with a BPD client, must be aware of not rupturing the therapeutic relationship. Conversely, substance abuse therapy groups focus specifically on participants' addiction and the group model permits greater opportunities for participants to challenge members who minimize the effects of their addiction. A substance abuse treatment group allows the client to begin working on addiction outside of individual therapy and preserving that counselor-client relationship. Therefore, the correct answer is (C) | treatment planning |
1,203 | Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual | The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others. | You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety. She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past. | Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.” | Based on the information provided, your client is most clearly demonstrating which of the following? | Anger at her partner for not reading her mind | Positive coping strategies of independence, strength, and control | Effective communication skills for sharing feelings | Anger with their decreased sex life | (A): Anger at her partner for not reading her mind
(B): Positive coping strategies of independence, strength, and control
(C): Effective communication skills for sharing feelings
(D): Anger with their decreased sex life | Anger at her partner for not reading her mind | A | The client's change in tone and eye contact away from her partner, as well as blaming her partner for her lack of involvement and participation in her cancer treatment, strongly suggests that the client believes her partner should have known what the client needed, without being told. This passive-aggressive style of communication often leads to angry emotions. The client's eye contact with the counselor and hurriedly wiping away tears also suggests angry emotions about the loss of intimacy, though this is likely to be connected to her partner not meeting the client's unexpressed needs. The client's communication style appears to be holding in her emotions and then allowing them to come out in anger. This is not an effective style of communicating with others. The client may be using her independence, strength, and control as coping strategies, but they isolate her from her partner more than unite her, thus they are not positive in these circumstances. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,204 | Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual | The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else. | You are a counselor in a private practice setting. Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car. She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger. | Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school. She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship. | Using the provided information, which of the following will best help you to understand the client's relationships with others? | Family Genogram | Thematic Apperception Test (TAT) | Minnesota-Multiphasic Personality Inventory-2 (MMPI-2) | Beck's Anxiety Inventory-II (BAI-II) | (A): Family Genogram
(B): Thematic Apperception Test (TAT)
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Beck's Anxiety Inventory-II (BAI-II) | Family Genogram | A | Completing and evaluating a family genogram will help identify unhealthy patterns and interactional dynamics. These patterns may have served the client well in childhood but have become problematic in her adult life. The MMPI-2 is used to assess personality traits and psychopathology. This may help the counselor determine a client's psychological state or a diagnosis, but it will not help explain the client's relationships with others. The BAI-II measures the client's current level of anxiety at a particular moment when the test is given. It is helpful as a pre- and post-test for monitoring anxiety levels, but will not add to the counselor's understanding of the client's relationship patterns with others. The TAT is a projective test that helps the counselor learn more about a client's emotional conflicts, themes within the client's life experience, psychological conditions, and may help the client to express their feelings in an indirect way. It does not provide specific information on the client's relationships with others. Therefore, the correct answer is (B) | counseling skills and interventions |
1,205 | Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center | The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy. | First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance. Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies. While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties. In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time. Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step. After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group. Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates. Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans. Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in. One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.” Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially. Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation. Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad "to go" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who "can eat anything whenever they want." She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating. You continue to explore the client's relationship with food by asking, "What do you think would happen if you ate whatever you wanted?" She replies, "I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person." After taking a moment to think, the client shares, "I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible. | The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as "strained" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. | After acknowledging the client's feelings regarding her weight, what cognitive distortion could you identify in her statement that might be hindering progress? | Discounting the Positive | Catastrophizing | Magnification | Mind reading | (A): Discounting the Positive
(B): Catastrophizing
(C): Magnification
(D): Mind reading | Catastrophizing | B | Catastrophizing is a cognitive distortion in which someone imagines the worst possible outcome will happen. In this case, it appears the client has convinced herself that if she eats extra food, she will suddenly become obese and never be able to stop eating. Then she'll be completely alone and it will be all her fault because she couldn't control her eating. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,206 | Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual | The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others. | You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety. She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past. | Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.” | Which of the following should be a priority during this first meeting with this client? | Assuming a non-judgmental stance | Demonstrating empathic attunement | Using redirection to help decrease negative thoughts | Acknowledging the client's diversity and intersectionality | (A): Assuming a non-judgmental stance
(B): Demonstrating empathic attunement
(C): Using redirection to help decrease negative thoughts
(D): Acknowledging the client's diversity and intersectionality | Demonstrating empathic attunement | B | Empathic attunement is a counselor's awareness of the client's emotional, somatic, and behavioral rhythms through tracking moment-to-moment changes and building a therapeutic connection demonstrating congruence and understanding. Attunement requires the counselor to emotionally engage with the client and their story and is the foundation of the therapeutic relationship. Acknowledging diversity and intersectionality and assuming a non-judgmental stance are both important parts of developing a therapeutic working relationship that allows the client to feel safe and understood during counseling. These are appropriate tasks but may be received as insincere if empathic attunement is not already present. Redirection to decrease negative thoughts may be helpful when using cognitive behavioral theory but should not be used when building the therapeutic relationship as the client may feel censured while telling their story. Therefore, the correct answer is (B) | professional practice and ethics |
1,207 | 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. Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a "new chance at living." She further discloses that she recently met a "wonderful man." They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that "he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me." She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different. From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. "He's always around when I need him," she explains, "And he listens to me and takes what I say seriously." The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, "If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared." You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts. | 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. | How could dialectical behavior therapy be used in this session to help the client navigate her newfound relationship? | Provide an empathetic and non-judgmental space for the client to explore her feelings about the relationship at her own pace | Encourage the client to practice mindful awareness of her feelings | Evaluate her early attachment experiences and discuss how this affects her interpersonal relationships | Explore feelings about unresolved past issues that may be impacting this relationship | (A): Provide an empathetic and non-judgmental space for the client to explore her feelings about the relationship at her own pace
(B): Encourage the client to practice mindful awareness of her feelings
(C): Evaluate her early attachment experiences and discuss how this affects her interpersonal relationships
(D): Explore feelings about unresolved past issues that may be impacting this relationship | Encourage the client to practice mindful awareness of her feelings | B | DBT emphasizes the importance of recognizing and acknowledging one's emotions, rather than suppressing them. In this session, DBT could be used to help the client navigate her newfound relationship by encouraging her to practice mindful awareness of her feelings. This would involve helping the client recognize and accept any positive or negative thoughts or emotions that arise as a result of her relationship. By doing so, the client will gain insight into what works for and against her in this relationship, allowing her to make more informed decisions about it going forward. Therefore, the correct answer is (C) | counseling skills and interventions |
1,208 | Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual | The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else. | You are a counselor in a private practice setting. Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car. She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger. | Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school. She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship. | Based on the information provided, which of the following diagnoses should the counselor suspect for this client? | Obsessive Compulsive Personality Disorder (OCPD) | Major Depressive Disorder (MDD) | General Anxiety Disorder (GAD) | Adjustment Disorder (AD) | (A): Obsessive Compulsive Personality Disorder (OCPD)
(B): Major Depressive Disorder (MDD)
(C): General Anxiety Disorder (GAD)
(D): Adjustment Disorder (AD) | Obsessive Compulsive Personality Disorder (OCPD) | A | The client is not only angry and irritated with her friend, who asserts control in their relationship, but she is also easily angered when her children don't put toys away in the right places or when her sister-in-law does not meet her moral expectations. Additionally, she described her husband, who was her opposite, as messy and not always on time, which led to problems and arguments. These factors suggest the client meets criteria for OCPD, which are: preoccupations with rules, order, and organization such that the point of the activity is lost; perfectionism that interferes with activities; scrupulous about matters of morality; and miserly toward others as evidenced by anger at being asked to borrow money. The client may be experiencing an adjustment due to the death of her husband, but the characteristics she relates were present before his death. The client relates some symptoms of depression and anxiety, but does not meet criteria for either. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,209 | 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. | sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time. You suspect that the client has post-traumatic stress disorder (PTSD) | You suspect that the client has post-traumatic stress disorder (PTSD). Which of the following does not meet the criteria for PTSD? | Difficulty with memory surrounding the traumatic event | Symptoms occur after at least 3 days following the traumatic event | Irritability | Poor concentration | (A): Difficulty with memory surrounding the traumatic event
(B): Symptoms occur after at least 3 days following the traumatic event
(C): Irritability
(D): Poor concentration | Symptoms occur after at least 3 days following the traumatic event | B | Within PTSD, the criteria for trauma symptoms requires that they must last longer than 1 month following the traumatic event. Acute stress disorder has similar criteria to PTSD, but it occurs only 3 days to 1 month following the traumatic event. Poor concentration, difficulty remembering the events of the traumatic event, and irritability are all symptoms of PTSD. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,210 | Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) | Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner | You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again. | vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week. When considering cultural concepts of stress, ataque de nervios is a condition commonly described by clients of Latino descent | When considering cultural concepts of stress, ataque de nervios is a condition commonly described by clients of Latino descent. Which one of the following symptoms is NOT typical of ataque de nervios? | Nausea | Sadness | Irritability | Vertigo | (A): Nausea
(B): Sadness
(C): Irritability
(D): Vertigo | Sadness | B | Ataque de nervios, although not an official diagnosis, is a commonly used idiom in the Latin culture that describes certain symptoms. Translated directly into an “attack of nerves,” sadness is not a common symptom of ataque de nervios because symptoms are more often based in anxiety. Irritability, nausea, and vertigo are symptoms commonly described by individuals complaining of these attacks. Therefore, the correct answer is (D) | counseling skills and interventions |
1,211 | 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. | null | What is the most important element to take into consideration when initially establishing your group? | Setting of the group | Issues at termination | Maintaining confidentiality outside the group | Having a psychiatrist on site | (A): Setting of the group
(B): Issues at termination
(C): Maintaining confidentiality outside the group
(D): Having a psychiatrist on site | Setting of the group | A | The group setting is the most important consideration because the group environment needs to be safe, private, consistently available. It should also be comfortable and contain adequate furniture. Therefore, the correct answer is (C) | professional practice and ethics |
1,212 | Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2) | Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta | You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race. | Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication | According to Jean Piaget, the client’s thinking can be characterized by which one of the following? | Can think about what-if or hypothetical situations | The ability to understand abstract ideas | Uses deductive reasoning and logic | Thinks concretely and begins to perform logical operations | (A): Can think about what-if or hypothetical situations
(B): The ability to understand abstract ideas
(C): Uses deductive reasoning and logic
(D): Thinks concretely and begins to perform logical operations | Thinks concretely and begins to perform logical operations | D | At age 7, the client thinks concretely and begins to perform logical operations. Piaget’s concrete operational stage of development occurs between the ages of 7 and 11. During this stage, children form mental operations or rules as evidenced by understanding concepts of conservation and reversibility. Piaget’s next stage of development (occurring at ages of 12+), is the formal operational stage, in which children and adults can use deductive reasoning and logic and think abstractly. Individuals in the formal operational stage of development also have the ability to think about what-if, or hypothetical, situations. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,213 | 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 is the rationale for providing educational materials to the client's parents as a way to help them begin to understand their child's situation? | This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome. | This provides more information in a shorter time, leaving more sessions for feedback and processing. | This will give information to the mother, to help her be more convincing in her discussions with the father. | This allows the parents to share the educational materials with the extended family | (A): This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome.
(B): This provides more information in a shorter time, leaving more sessions for feedback and processing.
(C): This will give information to the mother, to help her be more convincing in her discussions with the father.
(D): This allows the parents to share the educational materials with the extended family | This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome. | A | Gender Dysphoria is a sensitive subject in some families. Giving them resources is the best way to educate them and to support your client. Therefore, the correct answer is (C) | counseling skills and interventions |
1,214 | Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1) | Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par | You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby. | You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for | All of the following can be beneficial in improving attachment between the foster parents and the client EXCEPT: | Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family. | Encourage the parents to provide family activities focused on family cohesion. | Engage in one-on-one play daily with the client. | Provide physical affection and verbal reinforcement daily to the client. | (A): Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.
(B): Encourage the parents to provide family activities focused on family cohesion.
(C): Engage in one-on-one play daily with the client.
(D): Provide physical affection and verbal reinforcement daily to the client. | Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family. | A | Encouragement to visit the client’s birth parents should be a highly planned out event, should be coordinated with the foster care case manager, and should follow court recommendations. This kind of visit has the potential to cause harm to the client and also to the client’s relationship with her caregivers. One-on-one play, physical affection, verbal reinforcement, and family cohesion activities can all foster a more appropriate attachment between the client and the foster parents. Therefore, the correct answer is (D) | counseling skills and interventions |
1,215 | 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. | 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. | How will the client most likely compensate for the errors she makes during oral reading? | By excelling at physical activities | Through using memory and inference | By reading slowly | Through deflection | (A): By excelling at physical activities
(B): Through using memory and inference
(C): By reading slowly
(D): Through deflection | Through using memory and inference | B | Compensating using memory and inference is a technique that individuals with a reading disorder use because recognizing and memory help aid in the process. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,216 | Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81) | Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games. | You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling. | The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest | Given the client’s ability to describe what happens when he feels angry, how would you proceed? | Refer the client for a psychiatric medication evaluation. | Have the client keep a journal and record the relationship between behavioral symptoms and negative self-talk. | Teach the client relaxation techniques to use when experiencing associated physiological symptoms. | Request that the client’s teacher move the client’s desk back with the other students. | (A): Refer the client for a psychiatric medication evaluation.
(B): Have the client keep a journal and record the relationship between behavioral symptoms and negative self-talk.
(C): Teach the client relaxation techniques to use when experiencing associated physiological symptoms.
(D): Request that the client’s teacher move the client’s desk back with the other students. | Teach the client relaxation techniques to use when experiencing associated physiological symptoms. | C | Evidence-based practices for DMDD include cognitive-behavioral therapy and mindfulness-based interventions. Relaxation skills training is a mindfulness-based intervention. Since the client can identify physiological symptoms associated with feeling angry (eg, heart races, teeth clench, chest tightness), the next step would be to teach relaxation and other emotional regulation skills. Although medication can be prescribed to children with acute symptoms, this is generally initiated if therapy alone proves ineffective. Asking the client to keep a journal would not be appropriate for this client as there is currently no demonstration of insight or motivation. At present, requesting that the teacher move the client’s desk back with his peers is not in the client’s or the other students’ best interest. Therefore, the correct answer is (B) | counseling skills and interventions |
1,217 | Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center | The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, "I don't want to talk about anything here." | First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been "in his business" all the time, and he does not feel like he has any real privacy. You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him. You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others. You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way. Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session. Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and "taking it out on her" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict. The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth. Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group. 11th session The group as a whole has made progress, and members have found healthy outlets for expressing their thoughts and feelings. Rick has become more open with the women in the group and seems more receptive to what they have to say. Rick says that his grades have improved, his mother is proud, and he is encouraged by other group members who nod their heads and smile. The group has met its goals. The members have learned strategies to take with them as they prepare for termination. You remind the group that there are only a few more weeks left to meet. You begin to discuss the group members' feelings regarding the end of therapy. Rick starts to cry and says, "Why does every woman in my life cause problems for me?" The other group members offer Rick reassurance and empathy, but he continues expressing his frustration and sadness. You encourage the group to reflect on each person's progress and to be mindful of the emotions that this ending brings out. You explain to the group that endings can be difficult and that giving them permission to feel the emotions that arise during this transition is important. Rick is still struggling with the idea of ending the therapy and expresses his fear of being left alone. He continues to express his feeling that every woman in his life has caused him pain and suffering, and this group's ending has triggered his worst fears. You recognize his fear and attempt to validate his experience by emphasizing his progress in the group and the positive changes he has seen in himself. You explain that the group can support him through the transition and the other members offer encouraging words of encouragement. Rick is still anxious and overwhelmed. He talks about the difficulty of coping with the loss of the group and how he worries that he won't be able to manage his feelings without the support of the group. You explain to the group that it is natural to feel sadness and loss as well as gratefulness and pride in the progress they have all made. You encourage the group to identify the strategies they have learned in the group that they can use to manage their emotions. Finally, you assure Rick that he can use the skills he has learned in the group to cope with the emotions associated with the end of therapy. | The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed. Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. | What is the major contributing factor responsible for Rick's current feelings toward women from a gestalt point of view? | Cultural and familial expectations | Displaced anger being unable to express his feelings to his family | The trauma of his parent's separation | His sister's dominance over him from being oldest and most favored. | (A): Cultural and familial expectations
(B): Displaced anger being unable to express his feelings to his family
(C): The trauma of his parent's separation
(D): His sister's dominance over him from being oldest and most favored. | The trauma of his parent's separation | C | From a gestalt point of view, it is likely that Rick's feelings towards women stem from unresolved issues in his past. The major contributing factor to Rick's problems with women is the trauma of his parent's separation resulting from his mother's affair and his father leaving the family. This event caused significant disruption to the family and left Rick feeling abandoned by his father and betrayed by his mother. This resulted in Rick developing feelings of resentment and anger towards his mother, as well as other women in his life. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,218 | 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. | Leah has been sharing without pause for 30 straight minutes. It has been difficult to keep up with her changing topics and introducing new information. How do you help her to slow down? | Calmly interject, encourage her to take a deep breath, and refocus the dialogue | Interrupt with the observation and tell her to slow down | When she takes her next pause, ask her to stop and review only the highlights | Allow her to share however she needs to until she comes to a natural stop | (A): Calmly interject, encourage her to take a deep breath, and refocus the dialogue
(B): Interrupt with the observation and tell her to slow down
(C): When she takes her next pause, ask her to stop and review only the highlights
(D): Allow her to share however she needs to until she comes to a natural stop | Calmly interject, encourage her to take a deep breath, and refocus the dialogue | A | Modeling how to take a deep breath while she is sharing and helping her to refocus is the best choice for an intake and assessment session as you are specifically trying to organize your counseling strategies with her moving forward. This is a gentle and non-invasive intervention for helping Leah improve her session's quality. As her counselor, you are trying to get to know her and help her feel heard and understood at the same time; silently listening to her vent without being able to reflect, summarize, or ask questions to get to know her better is not necessarily more helpful for Leah. You are also responsible for completing this intake within a specific amount of time while honoring her VA benefit authorizations; while this does not take precedence over Leah's need for therapeutic engagement, it is an administrative aspect of professional counseling that is necessary for order and maintenance of boundaries. Answer a) projects a critical demeanor and may cause Leah to feel offended or stifled in her sharing, and answer d) is unnecessary as you are having her stop and repeat herself. Answer b) is not realistic if she has not taken a breath for 30 minutes and your intake is only scheduled to be 55 minutes. Therefore, the correct answer is (C) | counseling skills and interventions |
1,219 | 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 assessments would be least helpful in diagnosing the client's academic issues? | Wide Range Achievement Test - 5 (WRAT-5) | Kaufman Assessment Battery for Children II (KABC-II) | Wechsler Intelligence Scale for Children V (WISC-V) | Wechsler Adult Intelligence Scale IV (WAIS-IV) | (A): Wide Range Achievement Test - 5 (WRAT-5)
(B): Kaufman Assessment Battery for Children II (KABC-II)
(C): Wechsler Intelligence Scale for Children V (WISC-V)
(D): Wechsler Adult Intelligence Scale IV (WAIS-IV) | Wide Range Achievement Test - 5 (WRAT-5) | A | The WRAT-5 is an achievement test and can be used to determine how the individual is currently functioning in reading, math, spelling, and comprehension. It is used to screen individuals to identify those who need a more comprehensive evaluation. The WAIS-IV and WISC-V are both intelligence assessments that will identify if the client has a deficit in some area of intellectual functioning. The WAIS-IV tests from age 16 to adult and the WISC-V tests children up to and including age 16, so either of these may be helpful. The KABC-II tests for both achievement and intelligence and also can help in identifying learning disabilities so this will be a helpful test with this client. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,220 | 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 ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad | You ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad. Why are you engaging the client in this exercise? | To teach conflict resolution skills | To encourage a nonjudgmental stance | To identify core beliefs | To assess the client’s capacity for transference | (A): To teach conflict resolution skills
(B): To encourage a nonjudgmental stance
(C): To identify core beliefs
(D): To assess the client’s capacity for transference | To encourage a nonjudgmental stance | B | The purpose of this activity is to encourage the client to take a nonjudgmental stance. You are using a component of dialectical behavior therapy, which is an empirically validated approach for BPD. This approach targets black-and-white or all-or-nothing dialects that characterize common thinking patterns among individuals with BPD. Mindfulness-based exercises are used to help the client stay fully aware of the present (ie, here-and-now) moment. In this state of awareness, clients learn to accept and regulate intense emotions in a nonjudgmental fashion. Identifying core beliefs, teaching conflict resolution skills, and exploring transference and countertransference are also interventions for BPD; however, a nonjudgmental stance allows the client to have experiences that are “both-and” rather than “either-or”. Therefore, the correct answer is (D) | counseling skills and interventions |
1,221 | Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center | The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process. | First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor. You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying. You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, "I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else." You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a "tight schedule" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week. | null | What do you identify as a major stressor for this client? | Social isolation | English language barrier | High parental expectations | Financial obligations | (A): Social isolation
(B): English language barrier
(C): High parental expectations
(D): Financial obligations | Social isolation | A | The client stated that she has no friends and states that there is no possibility of meeting people at work because she is on a student visa and is not allowed to hold a job. She currently lives in dorm housing with a female roommate but feels homesick and isolated. Stressors like social isolation, loneliness, and the lack of a support network can lead to depression, anxiety, and suicidal ideation. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,222 | 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. Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly. The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being "too sensitive" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, "You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings." The client says, "I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under. You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way. 10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband. When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, "I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life." She goes on to describe it as "one of the most difficult decisions I've ever made." You ask her how she is feeling now that the decision has been made, and she tells you, "a little bit guilty, but mostly relieved." You affirm her courage and ability to handle such a challenging situation. She tells you that she "can finally breathe again." She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, "She and my dad looked so happy together. There was a time when she wasn't so critical and demanding." The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about "the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow." She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life. Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way." You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions. | 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 are researching the effectiveness of the communication skills which you have applied with your cross-cultural couple. As you analyze the results of your study, which of the following coefficients of correlation would indicate the strongest relationship? | 1.1 | -0.98 | 0 | 0.8 | (A): 1.1
(B): -0.98
(C): 0
(D): 0.8 | -0.98 | B | - 098 indicates a negative relationship between the effectiveness of the treatment and the communication skill techniques you are using. Of the answer options, this is the strongest relationship, even though it is a negative relationship. Therefore, the correct answer is (D) | professional practice and ethics |
1,223 | 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 a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations | How would a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations.” | As sadness resulting from the “I’m not OK,” “You’re OK” life position | As a mistaken style of life resulting from inferiority feelings | As a failure identity resulting from irresponsibly meeting the need for love | As incongruence stemming from a discrepancy between self-image and one’s ideal self | (A): As sadness resulting from the “I’m not OK,” “You’re OK” life position
(B): As a mistaken style of life resulting from inferiority feelings
(C): As a failure identity resulting from irresponsibly meeting the need for love
(D): As incongruence stemming from a discrepancy between self-image and one’s ideal self | As incongruence stemming from a discrepancy between self-image and one’s ideal self | D | Developed by Carl Rogers, client-centered therapy is based on the assumption that incongruence results from a discrepancy between one’s self-image and ideal self. Conditions of worth are created when an individual takes on a significant other’s condition of regard to the extent that self-experience is circumvented (or pursued). Alfred Adler adopted the belief that feelings of inferiority contribute to a mistaken style of life. According to William Glasser, credited with developing reality therapy, a failure identity occurs when the need for love is met in an irresponsible manner. Reality therapy, also known as control theory, emphasizes the importance of one’s need for love and the need to feel worthwhile. Eric Berne, credited with developing transactional analysis, viewed depression and sadness as the result of adopting the “I’m not OK; you’re OK” life position. Therefore, the correct answer is (B) | counseling skills and interventions |
1,224 | 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. Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly. The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being "too sensitive" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, "You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings." The client says, "I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under. You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way. 10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband. When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, "I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life." She goes on to describe it as "one of the most difficult decisions I've ever made." You ask her how she is feeling now that the decision has been made, and she tells you, "a little bit guilty, but mostly relieved." You affirm her courage and ability to handle such a challenging situation. She tells you that she "can finally breathe again." She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, "She and my dad looked so happy together. There was a time when she wasn't so critical and demanding." The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about "the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow." She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life. Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way." You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions. | 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. | Which strategy would be inappropriate during the termination phase with the client? | Clearly assessing the client's growth and development in therapy and the ways in which the client plans to sustain her progress | Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings | Helping the client to examine and process her feelings regarding the end of regular therapy sessions | Strategically evaluating the therapeutic process and examining what was effective and what needed to be improved from the client's standpoint | (A): Clearly assessing the client's growth and development in therapy and the ways in which the client plans to sustain her progress
(B): Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings
(C): Helping the client to examine and process her feelings regarding the end of regular therapy sessions
(D): Strategically evaluating the therapeutic process and examining what was effective and what needed to be improved from the client's standpoint | Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings | B | Exploring the unresolved emotional feelings the client may carry with her throughout life is not an appropriate strategy during the termination phase with the client. Instead, this should have been implemented during the active phase of therapy. Therefore, the correct answer is (C) | counseling skills and interventions |
1,225 | 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 | In this group, you will be working with clients that have Generalized Anxiety Disorder. According to the DSM-5-TR, what is considered a differential for Generalized Anxiety Disorder? | Panic Disorder | Agoraphobia | Schizoid Personality Disorder | Anorexia Nervosa | (A): Panic Disorder
(B): Agoraphobia
(C): Schizoid Personality Disorder
(D): Anorexia Nervosa | Panic Disorder | A | Panic Disorder is a differential for Generalized Anxiety Disorder. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,226 | Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate | Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam | You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server. | ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation. You are devoutly religious, and homosexuality goes against your personal beliefs | You are devoutly religious, and homosexuality goes against your personal beliefs. How should you handle personal values that conflict with those belonging to the client? | Seek training to help you avoid imposing your beliefs onto clients. | Refer the client to another provider whose values are more aligned with the client’s. | Ask the client to call your attention to any unintentional microaggressions that may occur during your clinical encounters. | Continue to work with the client as long your values are not openly discriminatory. | (A): Seek training to help you avoid imposing your beliefs onto clients.
(B): Refer the client to another provider whose values are more aligned with the client’s.
(C): Ask the client to call your attention to any unintentional microaggressions that may occur during your clinical encounters.
(D): Continue to work with the client as long your values are not openly discriminatory. | Seek training to help you avoid imposing your beliefs onto clients. | A | According to the ACA Code of Ethics (2014), “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” Answer C is the only answer option that reflects this ethical standard. Therefore, the correct answer is (C) | professional practice and ethics |
1,227 | Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00) | Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam | You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her. | ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.” The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing | The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing. How might a structural family therapist define the boundaries in the client’s family? | Clear | Disengaged | Diffuse | Flexible | (A): Clear
(B): Disengaged
(C): Diffuse
(D): Flexible | Diffuse | C | The client’s family boundaries can be described as diffuse. Structural family therapists focus on boundaries among family members. Boundaries are rules or barriers within a family system that dictate the amount of contact that members have with each other and the larger community. Families with diffuse boundaries are also described as enmeshed, which is observed in families who have become overly dependent on one another. Flexible boundaries occur when the boundaries are neither too closed and isolated nor too open and rigid. Flexible boundaries and clear boundaries are synonymous. Structural family therapists view healthy boundaries as those with the flexibility to adapt to stressors, communicate, and adjust limits when needed. Disengaged boundaries are rigid, and family members are isolated from one another. Therefore, the correct answer is (D) | counseling skills and interventions |
1,228 | Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1) | Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors | You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced. | You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice. The husband left the session | The husband left the session. What would be the most beneficial intervention for the couple? | Encourage the husband to return to the session. | Cancel the session in order to reconvene when the couple is willing to meet together because you are providing couples counseling. | Encourage both individuals to take responsibility for their contribution to the conflict. | Meet individually with both partners in order to process thoughts and feelings regarding the relationship. | (A): Encourage the husband to return to the session.
(B): Cancel the session in order to reconvene when the couple is willing to meet together because you are providing couples counseling.
(C): Encourage both individuals to take responsibility for their contribution to the conflict.
(D): Meet individually with both partners in order to process thoughts and feelings regarding the relationship. | Meet individually with both partners in order to process thoughts and feelings regarding the relationship. | D | The most beneficial intervention at this point would be to separate the partners and meet with them individually. This may be helpful in creating a more comfortable environment for expression for both partners. You will gain insight into each person’s perspective in a manner that is safer than the couples setting. It might be helpful to encourage the husband to return, but the couple is having trouble communicating, and getting each individual’s unbiased perspectives could be very helpful. It is also helpful to get individuals to take responsibility for their own actions, but the couple is not capable of this at this point in therapy because they are just starting to explore their emotions regarding the wife’s affair. Therefore, the correct answer is (C) | treatment planning |
1,229 | 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 | Which cardinal feature differentiates generalized anxiety disorder (GAD) from other anxiety-related disorders? | The presence of an acute stressor | Chronic apprehensive expectation | Intrusive thoughts or images | Separation from attachment figures | (A): The presence of an acute stressor
(B): Chronic apprehensive expectation
(C): Intrusive thoughts or images
(D): Separation from attachment figures | Chronic apprehensive expectation | B | The DSM-5-TR criteria for GAD includes excessive anxiety and worry (chronic apprehensive expectation). When the clinical presentation includes an acute stressor, the distress may be better explained by diagnoses such as post-traumatic stress disorder or acute stress disorder. Separation anxiety is considered when the distress is explained by separation from attachment figures. Lastly, obsessive-compulsive disorder is characterized by intrusive and unwanted thoughts or images. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,230 | Initial Intake: Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual | Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
| Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous. | null | Which of the following screening tools for substance use would not be appropriate for Sandy? | CRAFFT 2.0 | TAPS | DAST-10 | ANA | (A): CRAFFT 2.0
(B): TAPS
(C): DAST-10
(D): ANA | CRAFFT 2.0 | A | The CRAFFT 20 is for children 12-18 and would not be appropriate of Sandy. The tobacco, alcohol, prescription medication and other substance use- brief screening tool (TAPS) is only useful for screening of a forementioned drugs. The Drug abuse screening test- self screen (DAST) takes 5 minutes to yield quick results. The Addictions Neuroclinical Assessment (ANA) measures behavior, brain imaging and genetics for a comprehensive measure the levels and origins of addiction. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,231 | 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 is the best method for you to evaluate your counseling effectiveness with this client? | Ask the parents to provide feedback on your performance as a counselor | Evaluate the client's progress based on your observations of him during sessions | Evaluate the client's progress through regular check-ins and conversations with the parents | Rely on feedback from the client alone to measure success | (A): Ask the parents to provide feedback on your performance as a counselor
(B): Evaluate the client's progress based on your observations of him during sessions
(C): Evaluate the client's progress through regular check-ins and conversations with the parents
(D): Rely on feedback from the client alone to measure success | Evaluate the client's progress through regular check-ins and conversations with the parents | C | Evaluating the client's progress through regular check-ins and conversations with the parents, as well as any changes that they have seen in their son since attending family counseling sessions, is the best way to measure effectiveness as a counselor. This allows you to make sure that progress is being made and that any issues brought up during therapy sessions are being addressed. Therefore, the correct answer is (A) | treatment planning |
1,232 | 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 reflects the duration and frequency of symptoms needed for the client's diagnosis? | Four symptoms for at least six months | Two symptoms within the last six months | One symptom for at least three months | Six symptoms within the last 12 months | (A): Four symptoms for at least six months
(B): Two symptoms within the last six months
(C): One symptom for at least three months
(D): Six symptoms within the last 12 months | Four symptoms for at least six months | A | This answer has a sufficient length of time and number of symptoms to begin treatment for ODD. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,233 | 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. | Based on the information provided, why should the client be taught grounding and relaxation skills prior to working on deeper issues? | The client's support system members sometimes irritate her so she may not feel supported. | The client has likely experienced a significant trauma that could cause some disassociation. | The client's issues began in childhood and developmental regression is likely during processing. | Processing the client's issues may lead to increased negative thoughts and emotions. | (A): The client's support system members sometimes irritate her so she may not feel supported.
(B): The client has likely experienced a significant trauma that could cause some disassociation.
(C): The client's issues began in childhood and developmental regression is likely during processing.
(D): Processing the client's issues may lead to increased negative thoughts and emotions. | Processing the client's issues may lead to increased negative thoughts and emotions. | D | Clients in counseling often feel worse before they feel better as they face uncomfortable emotions, thoughts, and behaviors. The client has a history of criminal activity and an eating disorder that are often associated with a desire or need to control things and events in her life. It will be important to prepare the client for any increase in negative thoughts and feelings with coping strategies so the negative thoughts and emotions do not lead to negative behaviors. The counselor will support the client during therapy and the client may or may not choose to share her background and therapeutic work with her support system. There is no evidence that the client has previously regressed to a childlike state, that she has suffered trauma other than what has been explained to the counselor, or experienced disassociation. Coping strategies, which are helpful for all clients, are important for this client due to her history of coping through negative behaviors. Therefore, the correct answer is (B) | counseling skills and interventions |
1,234 | Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10) | Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia | You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone. | tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her | All of the following are appropriate assessment tools to explore differential diagnoses for major depressive disorder and PTSD, EXCEPT: | Adult ADHD Self-Report Scale | Generalized Anxiety Disorder-7 (GAD-7) | Adjustment Disorder-New Module 20 | Acute Stress Disorder Scale | (A): Adult ADHD Self-Report Scale
(B): Generalized Anxiety Disorder-7 (GAD-7)
(C): Adjustment Disorder-New Module 20
(D): Acute Stress Disorder Scale | Acute Stress Disorder Scale | D | Acute stress disorder would not be an indicated differential diagnosis; therefore, the Acute Stress Disorder Scale is not indicated here. Although it may be considered upon initial diagnosis, the client has experienced trauma symptoms over her lifetime. Acute stress disorder would not be diagnosed outside the timeframe of 3 to 30 days following the trauma exposure. Adjustment disorder would be appropriate to assess for because the client recently had some major life changes; however, the disturbances are likely a result of continuous exposure to trauma. Anxiety disorders should also be considered because PTSD has some symptoms that involve anxiety and panic. ADHD, though unlikely, could explain concentration issues and other symptoms that may appear in depression and PTSD. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,235 | 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. | Which of the following screening tools for alcohol use would not be applicable to John? | Rapid Alcohol Problems Screen (RAPS) | Adult Substance Use Survey (ASUS) | Brief Michigan Alcoholism Screening Test (BMAST) | Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD) | (A): Rapid Alcohol Problems Screen (RAPS)
(B): Adult Substance Use Survey (ASUS)
(C): Brief Michigan Alcoholism Screening Test (BMAST)
(D): Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD) | Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD) | D | The BSTAD is helpful for identifying risky substance use by adolescents age 12-17. The RAPS and BMAST instruments have both been proven effective in quickly screening adults for severity of alcohol use. The Rapid Alcohol Problems Screen was specifically noted in clinical trials to have increased sensitivity for and best performance results with the African American population. The ASUS is a 64-item self-report survey designed to assess an individual's perceived alcohol and other drug use and can be useful to gauge additional information that might indicate problems of emotional or mood adjustment. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,236 | Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng | You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially. | You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services | All of the following are primary focuses of the termination session, EXCEPT: | Signaling an end to the therapeutic relationship | Identifying that growth has occurred | Evaluating the effectiveness of therapy | Encouraging ongoing therapeutic changes | (A): Signaling an end to the therapeutic relationship
(B): Identifying that growth has occurred
(C): Evaluating the effectiveness of therapy
(D): Encouraging ongoing therapeutic changes | Evaluating the effectiveness of therapy | C | Evaluating the effectiveness of therapy should have occurred throughout the entirety of the counseling services; therefore, it is not a primary focus of termination. At the end of services, you want to focus on what the client has achieved and not on what you have done as a counselor. The termination session focuses on ending the relationship, encouraging the client to continue to use the learned skills without you, and helping the client to realize what has been accomplished. Therefore, the correct answer is (D) | professional practice and ethics |
1,237 | Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20) | Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam | You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together. | ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake | Which instrument would you use to assess this client for both problematic alcohol use and related psychological and emotional adjustment? | The Drug Abuse Screening Test (DAST) | The Alcohol Use Disorders Identification Test (AUDIT) | Cut Down, Annoyed, Guilty, and Eye-Opener (CAGE) | The Adult Substance Use Survey (ASUS) | (A): The Drug Abuse Screening Test (DAST)
(B): The Alcohol Use Disorders Identification Test (AUDIT)
(C): Cut Down, Annoyed, Guilty, and Eye-Opener (CAGE)
(D): The Adult Substance Use Survey (ASUS) | The Adult Substance Use Survey (ASUS) | D | The Adult Substance Use Survey (ASUS) is a 64-item questionnaire that assesses an individual’s perceived alcohol or substance use. There are additional questions designed to evaluate emotional difficulties and other mood-related issues. The Alcohol Use Disorders Identification Test (AUDIT) is used to help identify alcohol consumption, alcohol-related health problems, and drinking behaviors. The CAGE is a four-item screening instrument measuring an individual’s problematic alcohol use related to cutting down, others’ annoyance with one’s alcohol use, personal guilt over use, and alcohol use first thing in the morning. The Drug Abuse Screening Test (DAST) detects drug abuse and dependence and is not used to assess alcohol use or mood-related issues. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,238 | Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1) | Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par | You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby. | ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report | Which of the following symptoms would be needed to make a diagnosis of reactive attachment disorder? | Frequent tantrums. | The disturbance is evident before the age of 10. | Minimal response to comfort when distressed. | Difficulty making friends. | (A): Frequent tantrums.
(B): The disturbance is evident before the age of 10.
(C): Minimal response to comfort when distressed.
(D): Difficulty making friends. | Minimal response to comfort when distressed. | C | The only symptom required to make the diagnosis of reactive attachment disorder would be noted minimal or rare response to comfort when the client is experiencing strong emotions. Frequent tantrums may be evident in reactive attachment disorder; however, it is can also be an indication of other disorders. Difficulty making friends is not a criterion for reactive attachment disorder. The age range for reactive attachment disorder is 9 months to 5 years old. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,239 | Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School | The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate. | First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents "are the ones who need therapy, not me." She briefly describes the arguments that she claims her parents get into regularly. "They are always going at it, unless thay are at church. Then they act like everything is perfect." When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, "Can you tell me more about your relationship with your boyfriend? How long have you been together?" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a "big fight" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, "I don't know what to do." You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that "it will make it too real." You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several "in-home" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret. While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions. | The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had "high standards and expectations" for everyone in their family. The client says her parents "treat her like a child." She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. "One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up." | The client has shared a certain disaffection with her parents, and seemed reluctant to confide in the teacher who referred her to you. This could suggest a tendency in the client to have generational trust issues. How would you most effectively build a therapeutic alliance with this client? | Explore resources that are available to her. | Use self-disclosure of a difficult time in your past. | Remain neutral and validate her experience. | Examine why she is afraid to talk to her parents. | (A): Explore resources that are available to her.
(B): Use self-disclosure of a difficult time in your past.
(C): Remain neutral and validate her experience.
(D): Examine why she is afraid to talk to her parents. | Remain neutral and validate her experience. | C | This client is in a particularly vulnerable state right now. She has just found out that she is pregnant. She is scared to tell her parents and unsure of what to do next. You must create a safe space for her to process her situation. Remain neutral, regardless of your values and opinions, and validate her experience. Therefore, the correct answer is (A) | counseling skills and interventions |
1,240 | 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. | 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. | Which best describes the value of an Individualized Education Plan? | Engages the child in Autism group settings so that he can be exposed to other individuals with similar situations | Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting | Provides planned, intensive interventions to address the student's academic concerns | Enlists the care of an in-home specialist, school teachers, counselors, and other supports in the community | (A): Engages the child in Autism group settings so that he can be exposed to other individuals with similar situations
(B): Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting
(C): Provides planned, intensive interventions to address the student's academic concerns
(D): Enlists the care of an in-home specialist, school teachers, counselors, and other supports in the community | Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting | B | This is the value of an Individualized Education Plan. Therefore, the correct answer is (D) | treatment planning |
1,241 | Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes "doesn't feel like existing" when thinking about her injury. She shares that the thought of not being able to dance ever again is "too much to bear." Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support. | First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork. Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and "snaps" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, "She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care." After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her "life is ruined now" and "I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed." She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents. Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, "Why should I tell you anything else? You'll just tell my parents." You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, "Okay, I get what you're saying, but telling them about it has only made things worse." She reports that her parents now treat her "differently" and do not allow her access to any "dangerous items like kitchen knives" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, "I guess I can understand why they did it, but it still doesn't feel fair." You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them. You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, "I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been." You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, "I don't know...I've never really thought of myself as a teacher. I've always been the student." You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students. Seventh session Almost two months have passed since you first met with the client. She has been meeting you for weekly therapy sessions. During previous sessions, you continued to work on developing a sense of trust with the client which has allowed her to open up to you about the myriad of feelings that she has regarding her injury. You explored and processed feelings of grief and sadness, as well as feelings of anger and resentment. Several sessions have been dedicated to identifying automatic thoughts that have been contributing to the client's negative attitude and replacing negative self-talk like "I'm broken" with more positive and realistic statements. You have also been using solution-focused techniques to help her to focus on what is within her power to change and take active steps toward making those changes. During today's session, the client agrees with you when you state that you believe she has achieved many of her goals in therapy. The client has worked through her ambivalence towards teaching the younger ballet classes and is now actively pursuing this opportunity. She reports that she finds a sense of purpose in helping the students learn and appreciate dance, as well as feel accomplished for their achievements. She says, "It's still strange not being the student anymore, but I'm glad that I decided to try it. The kids had a performance last week, and one of the girls gave me this really sweet clay ballet shoe that she made in her art class. She told me that I'm the reason she felt 'brave enough' to keep dancing even though she was scared. That meant a lot to me." You then ask her about her relationship with her parents. She reports that it has improved since they had the discussion about trust. They are now more willing to listen to her opinions and have loosened some of the restrictions, though there are still some limits in place. Although they still have expectations of her and restrict certain activities, they now talk to her more openly and engage with her in a positive manner. She tells you that she would like to get all A's this semester to make her parents proud. She is getting better grades in history but states that her other classes are "boring." She also mentions wanting to put some limits on the amount of time she spends with her friends and "get away from smoking as much." She says that she is trying to be a better role model for her ballet students. You acknowledge how hard she has worked to reach this point and congratulate her on taking initiative in improving her academic performance and setting new boundaries with her friends. | The client reports that she is doing "okay" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle. | Using a solution-focused approach, how would you provide positive reinforcement for the client's progress and encourage her to continue working on her goals? | "I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?" | "What do you think would be the most helpful strategies for improving your grades in your other classes and setting healthy boundaries with your friends?" | "It's great that you want to make your parents proud by getting all A's this semester, but it's also important to remember that it's okay if you don't get perfect grades." | "It sounds like you have many goals that you want to accomplish, such as getting better grades, setting boundaries with your friends, and being a better role model for your students. What can you do right now to start working towards these goals?" | (A): "I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?"
(B): "What do you think would be the most helpful strategies for improving your grades in your other classes and setting healthy boundaries with your friends?"
(C): "It's great that you want to make your parents proud by getting all A's this semester, but it's also important to remember that it's okay if you don't get perfect grades."
(D): "It sounds like you have many goals that you want to accomplish, such as getting better grades, setting boundaries with your friends, and being a better role model for your students. What can you do right now to start working towards these goals?" | "I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?" | A | With this response, you are giving the client a compliment. A compliment as a technique in solution focused therapy is a way of acknowledging a person's strengths and successes in order to promote positive emotional states and to help focus on solutions rather than problems. Therefore, the correct answer is (A) | counseling skills and interventions |
1,242 | Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0) | Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through | You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational. | This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client and his brother are sitting on the floor playing with a building toy, which the client’s parents report is often a toy that causes him frustration because he plays very specifically with it and his brother does not want to play how he does. After about 5 minutes, the client becomes visibly frustrated as he is telling his brother to put a brick in a certain place because it is the same color and his brother says he is not going to and goes to build on his own. The client continues to build and asks for the piece repeatedly over a few minutes. The client then picks up what he is building and throws it against the wall and leaves the room | Based on the client’s diagnosis of autism and his presentation throughout these sessions, which of the following areas of the mental status exam may be outside of normal limits? | Orientation to person, place, time, and situation | Hygiene | Memory | Eye contact | (A): Orientation to person, place, time, and situation
(B): Hygiene
(C): Memory
(D): Eye contact | Eye contact | D | The client struggles with social skills; therefore, eye contact would likely not always be present or appropriate. The client does not appear to struggle with orientation or hygiene, although these may be factors for other individuals who have autism. Memory is not affected because the client does not have intellectual impairment. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,243 | 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. | 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. | What are you attempting to do by summarizing what the client tells you? | Facilitating steps that might assist the client in resolving her concerns | Determining the client's main issues as discussed during the session | Paraphrasing what the client is saying | Creating interventions to help the client better manage her concerns | (A): Facilitating steps that might assist the client in resolving her concerns
(B): Determining the client's main issues as discussed during the session
(C): Paraphrasing what the client is saying
(D): Creating interventions to help the client better manage her concerns | Determining the client's main issues as discussed during the session | B | During the initial intake it is always critical to be sure the therapist is clear about what is going on; otherwise, the tendency is to miss primary issues vital to stabilizing the client. Therefore, it is always helpful to carefully process what a client is saying, how they are saying it, and to what extent those concerns may be impacting them. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,244 | Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center | The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy. | First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance. Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies. While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties. In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time. Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step. After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group. Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates. Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans. Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in. One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.” Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially. Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation. Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad "to go" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who "can eat anything whenever they want." She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating. You continue to explore the client's relationship with food by asking, "What do you think would happen if you ate whatever you wanted?" She replies, "I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person." After taking a moment to think, the client shares, "I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible. | The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as "strained" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. | Given the client’s level of treatment and diagnosis, which of the following options would be the most appropriate combination to consult with regarding this client’s care? | PCP, nutritionist, and psychiatric nurse | PCP, nutritionist, and psychiatrist | Physician, academic advisor, and social worker | Case manager, psychiatric nurse, and nutritionist | (A): PCP, nutritionist, and psychiatric nurse
(B): PCP, nutritionist, and psychiatrist
(C): Physician, academic advisor, and social worker
(D): Case manager, psychiatric nurse, and nutritionist | PCP, nutritionist, and psychiatrist | B | A collaborative treatment plan would likely involve the client's Primary Care Physician, nutritionist, and psychiatrist for a client diagnosed with an eating disorder who is being treated in an outpatient setting. Therefore, the correct answer is (D) | treatment planning |
1,245 | 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. Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to "get some fresh air". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her. You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced. Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience. You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally. | 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 indicator provides the most comprehensive measure of the client's therapeutic progress up to this point? | Reduced frequency of nightmares | Utilizing calming techniques more effectively | Regaining meaning and purpose in life | Improved relationships with family and friends | (A): Reduced frequency of nightmares
(B): Utilizing calming techniques more effectively
(C): Regaining meaning and purpose in life
(D): Improved relationships with family and friends | Regaining meaning and purpose in life | C | By regaining a sense of purpose and direction, the client is able to move forward in her therapeutic journey even when faced with difficult emotions or memories associated with the traumatic event. This indicates that the client is making progress in terms of understanding and managing her symptoms, as well as developing coping strategies to help her manage distress. Therefore, the correct answer is (B) | treatment planning |
1,246 | 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 client's teacher has requested an update regarding the counseling process and the timeframe for referring the client to special education classes. What is the most appropriate response? | The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then. | The therapist should invite her to all sessions regarding the student. As a part of the IEP team, the teacher should have been part of the therapy process. | The therapist should forward all therapy notes to her. Since the teacher is part of the IEP team, she is privileged to all therapy sessions. | The therapist needs to take no action. The teacher no longer has a relevant part in the process. | (A): The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then.
(B): The therapist should invite her to all sessions regarding the student. As a part of the IEP team, the teacher should have been part of the therapy process.
(C): The therapist should forward all therapy notes to her. Since the teacher is part of the IEP team, she is privileged to all therapy sessions.
(D): The therapist needs to take no action. The teacher no longer has a relevant part in the process. | The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then. | A | As part of the IEP team, the teacher is privy to the outcomes of therapy related to recommendations for special education classes. The therapy notes themselves are private. Therefore, the correct answer is (A) | professional practice and ethics |
1,247 | 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 | All of the following are criteria for borderline personality disorder, EXCEPT: | Recurrent suicidal behavior | Binge eating | Inappropriate, intense anger or difficulty controlling anger | Recurrent depressive episodes | (A): Recurrent suicidal behavior
(B): Binge eating
(C): Inappropriate, intense anger or difficulty controlling anger
(D): Recurrent depressive episodes | Recurrent depressive episodes | D | Depressive episodes are not a symptom of borderline personality disorder. There is a long list of diagnostic criteria for borderline personality disorder, five of which must be present for diagnosis. One category of criteria for borderline personality disorder, according to the DSM-5-TR, is impulsive behavior, which includes binge eating in addition to excessive spending, inappropriate sexual relations, substance abuse, and dangerous driving. Intense anger and suicidal ideation are additional elements in the list of diagnostic criteria for borderline personality disorder. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,248 | Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) | Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa | You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills. | tion. Family History: The client has been married for 25 years. The client has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together | The Age Discrimination in Employment Act of 1967 and its amendments include all of the following EXCEPT: | Preferences based on age are prohibited. | Mandatory retirement of individuals in executive positions over age 65 years of age is permitted. | An employer should ensure that at least 20% of their workforce is older than 50 years of age. | Employers may reduce benefits based on age only if the cost of reduced benefits is the same as the cost of providing full benefits to younger workers. | (A): Preferences based on age are prohibited.
(B): Mandatory retirement of individuals in executive positions over age 65 years of age is permitted.
(C): An employer should ensure that at least 20% of their workforce is older than 50 years of age.
(D): Employers may reduce benefits based on age only if the cost of reduced benefits is the same as the cost of providing full benefits to younger workers. | An employer should ensure that at least 20% of their workforce is older than 50 years of age. | C | The employer is not required to have a specific percentage of the workforce that must be above a certain age according to the Age Discrimination in Employment Act of 1967 and its amendments. However, employers do have guidelines about mandatory retirement for individuals in executive positions and reductions in benefits. It is also prohibited to have preferences based on age for a position. Therefore, the correct answer is (A) | professional practice and ethics |
1,249 | Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual | The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others. | You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety. She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past. | Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.” | Considering the information provided, which question should the counselor ask at this time? | Why did her parent's divorce make the client feel anxious? | How has the client handled problems over her lifetime? | Would the client be open to attending a support group for cancer patients? | What makes the client feel most upset today? | (A): Why did her parent's divorce make the client feel anxious?
(B): How has the client handled problems over her lifetime?
(C): Would the client be open to attending a support group for cancer patients?
(D): What makes the client feel most upset today? | How has the client handled problems over her lifetime? | B | Regardless of counseling theory used, understanding the client's coping skills, including how they have changed over time provides the counselor with information on whether the client needs to be taught new coping skills or may already possess skills that can be used in therapy. The counseling profession is a strengths-based model and solidifying past strengths or installing new ones is a primary goal in counseling. Support groups for cancer patients are specifically focused on the needs that these individuals face with their disease. It may be an effective concurrent therapy for this client at a later date, but the client's current expectation is individual therapy as evidenced by coming to counseling. Asking the client about today's feelings only does not demonstrate that the counselor heard the client's story as many of the past and current concerns of the client were already stated. Exploring the client's emotions related to her parent's divorce may be a good intervention but asking "why" questions is not good counseling practice as it may make clients feel defensive. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,250 | 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. Sixth session The client has not been following through with her mood journal. She says that she "got bored and didn't feel like writing in it anymore." During this session, a month and a half into therapy, she relays an incident that happened with the friend she went to visit out-of-state. They argued due to political differences and are currently not talking to each other. The client now considers her friend "a drunk who doesn't know what she's talking about." You suggest that the client's anger and judgment may be a defense that she uses to avoid feeling rejected as she did with her father. You state, "It seems that in an attempt to avoid feeling hurt and rejected, you use anger and alcohol to push people away." The client responds with reflective silence and begins to tear up. You guide the client to examine her defensive behavior and understand why she relies on it when faced with difficult emotions. You emphasize that her feelings of hurt, rejection, and anger are valid, however, they can be managed in healthier ways. You suggest that part of processing these feelings is to recognize them and make attempts at reconnecting with her friend. Additionally, you recommend cultivating self-care practices. The client acknowledges the importance of looking after herself during this difficult time, understanding that if she is able to take care of herself first she will be in a better position to address her relationships. You remind the client that it is important to take steps to move forward, even if those steps are small. You highlight her willingness to talk through her emotions and gain insight into her reactions as an opportunity to grow in self-awareness. You explain that having knowledge of one’s own feelings helps them to make better decisions and boundaries, which can lead to healthier relationships with others and ultimately, more peace within oneself. With this understanding, you create a plan of action together for how she will move forward between now and your next session. You close the session by telling the client that she has made progress today by having gained insight into her feelings, and that will lead to exploration of how to respond to them more productively. You conclude by encouraging her to keep exploring new methods of self-care and to bring up any additional topics she wants to discuss in the next 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 of the following is most indicative of your effectiveness in treating this client? | She has gained insight into her feelings. | She is beginning to address her unresolved relationship issues with her father. | She is becoming more expressive of her feelings. | She is exploring her struggles more openly. | (A): She has gained insight into her feelings.
(B): She is beginning to address her unresolved relationship issues with her father.
(C): She is becoming more expressive of her feelings.
(D): She is exploring her struggles more openly. | She has gained insight into her feelings. | A | The primary issue is her mood dysregulation. The fact that she has a deeper, more appreciative understanding of her feelings indicates a greater level of effectiveness in her treatment outcome. These breakthroughs allow the client to feel empowered and look at a situation more realistically, leading to improved understanding and self-awareness. She is then able to move forward and change behaviors due to this understanding. Therefore, the correct answer is (A) | treatment planning |
1,251 | Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision | The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter "does not listen," "acts out all the time," and "picks fights with her sister." The client is reticent and shrugs her shoulders. The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment. | First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, ""Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father." The client interrupts and says, "It's not Dad's fault! You're the one who abuses me!" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a "liar, a thief, and creates problems." She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault. The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family. After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action. | The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a "messy divorce," and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness. The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness. The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs "help." The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. | Based on the mother's disclosures in today's session, what will you focus on during the next counseling session with the client? | Work on establishing trust and rapport with the client | Assess the client's needs and develop a treatment plan | Determine the details of the client's relationship with her father | Explore the client's relationship with her parents | (A): Work on establishing trust and rapport with the client
(B): Assess the client's needs and develop a treatment plan
(C): Determine the details of the client's relationship with her father
(D): Explore the client's relationship with her parents | Assess the client's needs and develop a treatment plan | B | The goal of the next counseling session should be to assess the client's needs and develop an appropriate treatment plan. This will involve exploring the client's relationship with her mother and her father, along with understanding the issues that are leading to her lying and theft. Only after a comprehensive assessment can a treatment plan be developed that is tailored to the client's individual needs. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,252 | Initial Intake: Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual | Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife. | Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.
History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him. | null | The counselor recently lost her father, so she feels sad to hear about Theodore's loss. She has a sudden urge to buy Theodore some groceries, so he has food at home. This is an example of? | Countertransference | Empathy | Case management | Transference | (A): Countertransference
(B): Empathy
(C): Case management
(D): Transference | Countertransference | A | Countertransference occurs when something in the therapeutic relationship brings up feelings for the counselor due to unresolved needs or personal conflicts. If the counselor recently lost her father and has a need to do something outside of her role, this is an example of countertransference. It is important for the counselor to recognize this and bring this to a colleague or supervisor. It would not be appropriate to work this out in the client's session. Transference occurs when the client projects their feelings, desires and drives onto the counselor. Case management is a service in which a client is set up with resources. An example of Case Management would be referring Theodore to a pantry or helping him to apply for food stamps. Empathy is an important skill to have as a counselor. It allows the counselor to put themselves in the shoes of their clients. Although the counselor may be feeling empathy, this is an example of the counselor's urge to attend to her own needs, not the needs of the client. Therefore, the correct answer is (B) | counseling skills and interventions |
1,253 | 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 interventions will be most beneficial to help the client in addressing his relationships within the context of his narcissistic traits? | Learning to engage in recreational activities that his wife finds important | Learning to recognize and respect boundaries | Learning to organize himself so he is not easily distracted | Learning to internalize the compliments he receives from his supervisor | (A): Learning to engage in recreational activities that his wife finds important
(B): Learning to recognize and respect boundaries
(C): Learning to organize himself so he is not easily distracted
(D): Learning to internalize the compliments he receives from his supervisor | Learning to recognize and respect boundaries | B | Learning to recognize and respect boundaries is the most important intervention to focus on because people with NPD and narcissistic traits often do not see or will ignore others' boundaries to meet their own needs. Understanding where the self ends and another person begins is an important feature of boundaries and is critical for the client to attend to in relationships. Engaging in recreational activities that require more physical activity and thrill-seeking is more related to his attention deficit, hyperactivity type, rather than his narcissistic traits. Organizing himself to decrease distraction is also more related to his ADHD, attention/distraction type. Learning to internalize compliments will help the client improve self-esteem and will, over time, help him reduce the instances of self-esteem injury, but this is a long-term goal and will not be an intervention at this time in therapy. Therefore, the correct answer is (D) | counseling skills and interventions |
1,254 | Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice | The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature. The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation. | First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are "roommates" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome. Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is "officially sleeping in the spare bedroom" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, "We don't talk anymore. He just berates me all the time, and that hurts a lot." As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, "She's a mess. I don't know what to say." You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed. Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship. Seventh session You met previously with each partner separately. They shared their perspectives with you about their relationship. The husband told you that he was reluctant to stay with his wife. The wife described feelings of worthlessness and loneliness. Today, the husband arrives for their couples session ten minutes after the wife, as they are driving in separate cars. The husband states that he is bored at home and is tired of his wife "nagging" him. The wife rolls her eyes and expresses that she will never be a priority, and the husband blames her for everything that goes wrong. The wife is now staying at her friend's house, and the husband is relieved that she is gone. You talk to the couple about their perceived outcomes in therapy and what they hope to accomplish going forward. | The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps "take the edge off." The client states he would rather deal with the pain than be emotionally blunted. | The husband tells his wife that he feels pressured by her focus on sex. The wife responds back to him calmly, stating how she feels. You want to encourage them to continue speaking with one another. What would be most helpful for you to do at this point? | Agree with the husband | Agree with the wife | Use listening skills | Interrupt them | (A): Agree with the husband
(B): Agree with the wife
(C): Use listening skills
(D): Interrupt them | Use listening skills | C | If they are communicating calmly with each other, it is important for you to listen and reflect with them. Therefore, the correct answer is (C) | core counseling attributes |
1,255 | Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple | The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. | You are a counselor in a private practice setting. Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her. He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.” Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously. | Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure. | Based on the information provided, which of the following diagnoses is most appropriate for the couple's situation at this time? | Post Traumatic Stress Disorder (PTSD) | Adjustment Disorder (AD) | Major Depressive Disorder (MDD) | General Anxiety Disorder (GAD) | (A): Post Traumatic Stress Disorder (PTSD)
(B): Adjustment Disorder (AD)
(C): Major Depressive Disorder (MDD)
(D): General Anxiety Disorder (GAD) | Adjustment Disorder (AD) | B | The couple as a whole and individually are exhibiting signs of an Adjustment Disorder. The stated problems occurred within three months of the infertility issues (Criterion A), the significant decrease in communication (ie, less than five words a day) and intimacy are out of proportion to the severity of the stressor (Criterion B. 1), and does not appear to meet conditions for another disorder, does not represent bereavement (death of a loved one), though may represent grief, related to loss of dreams or goals. The couple do not provide evidence of a traumatic event suitable for a diagnosis of PTSD. Jane presents some symptoms of a MDD, though she does not meet full criteria at this time, though the counselor would continue to monitor her. John presents some symptoms of anxiety but does not qualify for a diagnosis of GAD. Adjustment disorders may include specifiers of anxiety and depressed mood, which encompass the symptoms that the individuals as a couple are currently exhibiting. A counselor would monitor each individual closely in case the Adjustment Disorder develops into a more severe diagnosis (Criterion C - the stress-related disturbance does not meet the criteria for another mental disorder). Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,256 | Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1) | Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors | You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced. | eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin | Which one of the following is NOT a criterion for adjustment disorder? | Significant stress that impairs social, occupational, or other areas of functioning | Symptoms that are not based on a normative stress reaction | Emotional and behavioral symptoms that start within 3 months of a stressor | The presence of psychotic features | (A): Significant stress that impairs social, occupational, or other areas of functioning
(B): Symptoms that are not based on a normative stress reaction
(C): Emotional and behavioral symptoms that start within 3 months of a stressor
(D): The presence of psychotic features | The presence of psychotic features | D | The presence of psychotic features is not a specifier for adjustment disorder, but the following specifiers might apply: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions or conduct, or unspecified. The specifier used for this couple is “with anxiety” because there is anxiety present about the future of their relationship. All of the other listed criteria (symptoms occurring within 3 months of the stressor, impaired functioning, and symptoms that are not based on a normative stress reaction) apply to adjustment disorder. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,257 | 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 interventions would not be included in psychodynamic therapy aimed at increasing the client's level of insight and awareness? | Transference | Identifying core beliefs | Content vs. process | Free association | (A): Transference
(B): Identifying core beliefs
(C): Content vs. process
(D): Free association | Identifying core beliefs | B | Identifying core beliefs is a useful intervention in cognitive behavioral therapy, not psychodynamic therapy. Psychodynamic therapy is unstructured and makes use of the relationship between the client and counselor (transference and countertransference), free association to help the client and counselor explore how the conscious and unconscious are influencing the client, and content vs process in which the counselor helps the client explore their communication at both conscious and unconscious levels and what is meant by their verbal or behavioral communication. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,258 | 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. | You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy. You suspect that client 1 is actually experiencing symptoms consistent with antisocial personality disorder | You suspect that client 1 is actually experiencing symptoms consistent with antisocial personality disorder. Which one of the following statements best characterizes antisocial personality disorder? | Severe introversion that keeps the individual from participating in daily activities | Disregarding or violating the rights of others | Argumentative/irritable/defiant behavior | Grandiosity, lack of empathy, and a need for admiration | (A): Severe introversion that keeps the individual from participating in daily activities
(B): Disregarding or violating the rights of others
(C): Argumentative/irritable/defiant behavior
(D): Grandiosity, lack of empathy, and a need for admiration | Disregarding or violating the rights of others | B | Antisocial personality disorder is defined by behavior that violates or disregards the rights of others. Argumentative, defiant, and irritable behaviors characterize oppositional defiance disorder, which is defined by persistent opposition to authority figures. Grandiosity, a need for admiration, and lack of empathy characterize narcissistic personality disorder. Severe introversion is not specific to antisocial personality disorder and would likely need further assessment to determine its cause. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,259 | 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. Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears "frazzled" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that "this has been going on long enough" and that she needed to "get her act together." After this conversation, the client experienced a panic attack and stated that she was "terrified" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital. You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into "fight, flight, or freeze" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, "I'm ruining my family. What if I die? Who will take care of the kids?" You provide empathy and walk her through a relaxation technique. | 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. | Given that the client went to the emergency room with severe dyspnea and fear of dying from myocardial infarction and seems to be decompensating, what therapy would you now consider? | Selective serotonin reuptake inhibitors (SSRIs) | Exposure therapy | Group therapy | Cognitive-behavioral therapy (CBT) | (A): Selective serotonin reuptake inhibitors (SSRIs)
(B): Exposure therapy
(C): Group therapy
(D): Cognitive-behavioral therapy (CBT) | Cognitive-behavioral therapy (CBT) | D | CBT is the most effective treatment for panic disorder, focusing on changing negative thought patterns and behaviors associated with panic attacks. It is an evidence-based approach that helps patients to identify and challenge unhelpful or inaccurate thoughts associated with the disorder. It also teaches relaxation techniques, such as breathing exercises and progressive muscle relaxation, to help manage physical symptoms of anxiety. Additionally, CBT encourages individuals to gradually face their fears in order to desensitize them from panic attack triggers. Therefore, the correct answer is (B) | treatment planning |
1,260 | 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. | Considering the information provided, which question will be most effective to ask when setting treatment goals for the client? | All of the above | Which is most important to work on: your depression, narcissistic traits, or ADHD? | What have you tried in the past to make changes that haven't worked? | What do you hope to gain from working together in counseling? | (A): All of the above
(B): Which is most important to work on: your depression, narcissistic traits, or ADHD?
(C): What have you tried in the past to make changes that haven't worked?
(D): What do you hope to gain from working together in counseling? | What do you hope to gain from working together in counseling? | D | When setting goals, it is important for the client to want to make changes in counseling so having the client identify what they would like to gain from your work together will be an important first step in developing appropriate goals. Presenting the client with multiple and/or potential diagnoses can be disheartening and shaming to the client who is asking for help and looking for hope through counseling. Using behavioral terms to set goals would be a more appropriate, encouraging, and collaborative way of developing goals with a client. Asking the client what has not been helpful in the past may be a part of setting up interventions, but goal setting should be framed positively and focus on client's strengths and resilience as these are foundational to the counseling profession. All of the above is not correct as responses b and c are not appropriate for setting goals. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,261 | 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 would be the counselor's next step in working with this client? | Explain to the client's school that she is experiencing hallucinations and delusions | Express your concerns to client's mother and have her choose the next step | Enroll the client in a social skills group for adolescents to build social skills | Refer to psychiatry for medication evaluation | (A): Explain to the client's school that she is experiencing hallucinations and delusions
(B): Express your concerns to client's mother and have her choose the next step
(C): Enroll the client in a social skills group for adolescents to build social skills
(D): Refer to psychiatry for medication evaluation | Refer to psychiatry for medication evaluation | D | The client should be referred to psychiatry for medication evaluation to treat her schizophrenia and depressive symptoms. Schizophrenia does not resolve on its own and the client will likely require medication throughout her lifetime. Once she has been evaluated and medication is prescribed, the counselor and parent will notify the school of any concerns regarding the client. Enrolling the client in a social skills group may be helpful after medication has been instituted as she will need to learn skills in communicating appropriately with others while feeling limited by her medication. Medications for schizophrenia have side effects that make it difficult for individuals to engage with others. It is appropriate for the counselor to express concerns to the client's mother, but this should be done while providing the treatment options rather than asking the mother how to handle the situation as she does not have the expertise about the disorder and treatment that the counselor possesses. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,262 | 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 is a common premorbid condition that often precedes Conduct Disorder? | Reactive Attachment Disorder | Oppositional Defiant Disorder | Intermittent Explosive Disorder | Premature Conduct Disorder | (A): Reactive Attachment Disorder
(B): Oppositional Defiant Disorder
(C): Intermittent Explosive Disorder
(D): Premature Conduct Disorder | Oppositional Defiant Disorder | B | ODD is the condition that often develops into Conduct if untreated or unresolved. RAD is a condition found in children who don't form healthy emotional attachments with their primary caregivers before the age of 5, often due to neglect. IED is marked by episodes of unwarranted anger with behavioral outbursts that are out of proportion to the situation. Premature Conduct Disorder is not a real term. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,263 | Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) | Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner | You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again. | vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week. The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines | The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines. Considering the location of the children, which of the following is the most ethical clinical decision? | Your main client, the father, is in your state; therefore, it is okay to have a family session. | You consult with the state boards of both states and follow their recommendations. | You cannot provide counseling to the children while also counseling their father, so you provide referrals to a counselor licensed in both states. | You cannot provide a therapy session to the client’s children because they are in a state in which you are not licensed. | (A): Your main client, the father, is in your state; therefore, it is okay to have a family session.
(B): You consult with the state boards of both states and follow their recommendations.
(C): You cannot provide counseling to the children while also counseling their father, so you provide referrals to a counselor licensed in both states.
(D): You cannot provide a therapy session to the client’s children because they are in a state in which you are not licensed. | You consult with the state boards of both states and follow their recommendations. | B | Different states have varying rules for providing across-state counseling services. It is always important to consider state regulations regarding cross-border counseling services prior to providing counseling. Simply providing referrals may meet the family’s needs; however, it would be more helpful to the client to find out more about the states’ regulations. You cannot move forward with providing a session just because the father lives in the state you are licensed in. Therefore, the correct answer is (D) | professional practice and ethics |
1,264 | Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic Type of Counseling: Individual | Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact. | Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things. | null | Which referral would be most beneficial to Carlos? | Narcotics anonymous | Military school | Big Brother/Big Sisters | Alcoholics anonymous | (A): Narcotics anonymous
(B): Military school
(C): Big Brother/Big Sisters
(D): Alcoholics anonymous | Big Brother/Big Sisters | C | Big Brothers/Big Sisters may be a beneficial program which would provide Carlos with a positive role model. Additionally, Carlos is lacking a positive male role model. There is no indication that Narcotics or Alcoholics anonymous are warranted at this time. Military school would not address the underlying psychopathology. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,265 | 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. | You decide not to share his mother's inattention in the second session with Raul. By doing this, you are avoiding all except which of the following outcomes? | Harming Raul's relationship with mom | Increasing Raul's perception or feelings of neglect | Inadvertent backlash onto your therapeutic alliance | Derailing the session's planned interventions | (A): Harming Raul's relationship with mom
(B): Increasing Raul's perception or feelings of neglect
(C): Inadvertent backlash onto your therapeutic alliance
(D): Derailing the session's planned interventions | Derailing the session's planned interventions | D | Sessions with your client should be viewed as taking the time to address what is needed to achieve treatment plan goals. This may often include many derailments from your planned interventions so that greater objectives can be reached. Flexibility is significant when providing care that involves volatile emotional content and processes. Therefore, the correct answer is (D) | counseling skills and interventions |
1,266 | 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. | Based on the information provided, which intervention should be completed in this first meeting? | Provide educational materials on academic disabilities | Develop a safety plan for the client and the family | Schedule client for psychological and academic testing | Teach client a relaxation method to help her contain emotions | (A): Provide educational materials on academic disabilities
(B): Develop a safety plan for the client and the family
(C): Schedule client for psychological and academic testing
(D): Teach client a relaxation method to help her contain emotions | Develop a safety plan for the client and the family | B | The client denies any suicidal or homicidal ideations but at least one occurrence has been reported where the client threatened her sister with a knife. Safety of the client and others is the first level of Maslow's hierarchy and is the priority needed for this family before leaving the intake meeting. Scheduling the client for any testing will be an important piece of treatment and while it may be efficient, it is not necessary that testing is scheduled prior to leaving this meeting. The client has not been tested so providing education on academic disabilities would be inappropriate. Teaching the client relaxation methods may be helpful at some point but given the client's current presentation, she may not understand the strategies or be able to implement them at this time. Therefore, the correct answer is (A) | treatment planning |
1,267 | 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. | 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. | What would be potential risk factors necessary to consider in the creation of a safety plan for this client? | The client's recent changes in medication. | The client's disorder, self-harm, use of substances, previous hospitalization, and family history. | The client's current economic status. | Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history. | (A): The client's recent changes in medication.
(B): The client's disorder, self-harm, use of substances, previous hospitalization, and family history.
(C): The client's current economic status.
(D): Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history. | Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history. | D | The client has several risk factors. This answer captures most of the client's current risk factors. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,268 | 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 | Reiterate that the practice of using coping skills is a long-term learning process. | Provide feedback that because he is still struggling, he should continue practicing. | Include them anyway because it is not up to the client. | Explain that coping skills go in everyone's chart, and he shouldn't feel bad. | (A): Reiterate that the practice of using coping skills is a long-term learning process.
(B): Provide feedback that because he is still struggling, he should continue practicing.
(C): Include them anyway because it is not up to the client.
(D): Explain that coping skills go in everyone's chart, and he shouldn't feel bad. | Reiterate that the practice of using coping skills is a long-term learning process. | A | Providing our clients with education on the pervasive, life-long challenge of learning and applying coping skills is a great way to validate and encourage them to keep practicing. Reframing their goals in the form of ongoing efforts can be motivational in nature, without leaving them feeling ashamed they have not mastered a previously attempted goal like in answer d). It is not best practice to write treatment plan goals the client is refusing to work on, like in answer a), and saying “coping skills go in everyone's chart” in answer b) is minimizing your clinical feedback that he specifically needs to work on them. Therefore, the correct answer is (C) | null |
1,269 | 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, which one is NOT an accurate depiction of the use of motivational interviewing (MI)? | Counselors take a direct approach during the initial phases of MI. | Counselors support the client’s self-efficacy. | Counselors leave the decision up to the client to change. | Counselors use strategies to elicit change talk. | (A): Counselors take a direct approach during the initial phases of MI.
(B): Counselors support the client’s self-efficacy.
(C): Counselors leave the decision up to the client to change.
(D): Counselors use strategies to elicit change talk. | Counselors take a direct approach during the initial phases of MI. | A | Counselors do NOT take a direct approach during the initial phases of MI. MI is a person-centered, strengths-based approach used to reduce ambivalence and evoke lasting behavioral change. The counselor functions as a facilitator rather than an expert and guides the patient toward change. At no time is MI direct in nature, even in the initial phases. Counselors using MI emphasize autonomy, self-efficacy, and the use of evocation to elicit change talk. Therefore, the correct answer is (B) | counseling skills and interventions |
1,270 | 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. | As you begin the intake, the client appears anxious and states that he has many things he wants to share with you and says he "needs to get all these things off his chest." What discussion should you have with him before you begin? | Discuss the non-judgmental nature of the counseling process | Review limits of confidentiality | Remind him that he will set the pace for what he needs to share with you | Give permission for him to share slowly so he doesn't later regret his vulnerability | (A): Discuss the non-judgmental nature of the counseling process
(B): Review limits of confidentiality
(C): Remind him that he will set the pace for what he needs to share with you
(D): Give permission for him to share slowly so he doesn't later regret his vulnerability | Review limits of confidentiality | B | Counselors are required to discuss the limits of confidentiality with all clients prior to counseling. This client has a history of suicidal ideation and intent so the counselor must review the circumstances that would require breaking confidentiality to protect the client from self-harm. Discussing the nature of counseling is important as is allowing the client to set the pace for self-disclosure based on the growing therapeutic relationship. Research has shown that clients who overshare too early in the counseling relationship often regret their vulnerability and may discontinue counseling due to embarrassment or shame. Therefore, the correct answer is (C) | professional practice and ethics |
1,271 | 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. | Using the provided information, for which diagnoses should the counselor assess? | Bipolar I Disorder and Rumination Disorder | Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder | Obsessive Compulsive Personality Disorder and Intellectual Disability | Bipolar I Disorder and Obsessive Compulsive Disorder | (A): Bipolar I Disorder and Rumination Disorder
(B): Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder
(C): Obsessive Compulsive Personality Disorder and Intellectual Disability
(D): Bipolar I Disorder and Obsessive Compulsive Disorder | Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder | B | The counselor should assess for symptoms of OCPD and Attention Deficit/Activity Disorder (ADHD) as the client demonstrates symptoms that meet criteria for OCPD (preoccupation with details, rules, order, and organization; perfectionism; excessive devotion to work to the exclusion of leisure activity) and symptoms that meet criteria for ADHD (fidgets or squirms in seat; difficulty remaining seated when expected to; talks excessively; blurts out answers before questions are completed). Research shows that ADHD shows a high comorbidity for some personality disorders such as OCPD. Response a is incorrect because the client has not demonstrated any symptoms related to bipolar I disorder such as being more talkative "than usual," inflated self-esteem or grandiosity, racing thoughts and decreased need for sleep, or involvement in high-risk activities. Response b is incorrect as there are no symptoms presented that are congruent with an intellectual disability. The client has completed college and owns his own business. Response c is incorrect because rumination disorder is a disorder of eating, not cognitive thought or personality. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,272 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0) | Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso | You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being. | mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic | Due to the client’s reported suicidal ideation, which of the following would be an appropriate intervention regarding management of suicide risk? | Create a safety plan. | Encourage the client to stay with his girlfriend so he is not alone. | Coordinate for placement in a psychiatric hospital to safely address the crisis. | Provide psychoeducation on cognitive reframing in order to manage depressive symptoms. | (A): Create a safety plan.
(B): Encourage the client to stay with his girlfriend so he is not alone.
(C): Coordinate for placement in a psychiatric hospital to safely address the crisis.
(D): Provide psychoeducation on cognitive reframing in order to manage depressive symptoms. | Create a safety plan. | A | A safety plan would be the best first intervention because suicidal ideation is present, but without an intent or plan. A safety plan provides options for coping with negative thoughts and lists the people that the client can contact for support. Cognitive reframing will be beneficial in treating depression and at times suicidal thoughts, but this would not be taught quickly and effectively enough to assist the client in the first session. Encouragement to stay with his girlfriend may provide safety and/or be part of the safety plan, but it will not guide the client on how to manage his thoughts in the way that the safety plan would. Placement in a psychiatric hospital is not always necessary when someone has suicidal thoughts, and this may enhance the client’s anxiety. Further questioning and assessments can be used to ensure that someone is at low risk for suicide and if they are lower risk, they can likely be stabilized in the community with a safety plan. Therefore, the correct answer is (B) | treatment planning |
1,273 | 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. | During the subsequent joint session, the client's father states, "All these problems he has are because he wants to be a girl." Which of the following psychoeducation statements addresses this statement? | "I agree, but do you really think we can force your child to act a certain way?" | "We are working to treat the client for gender dysphoria, not gender nonconformity." | "It would be best if you started using the client's preferred pronouns." | "Often, the problem is not a child's gender expression but how those around them react to that expression." | (A): "I agree, but do you really think we can force your child to act a certain way?"
(B): "We are working to treat the client for gender dysphoria, not gender nonconformity."
(C): "It would be best if you started using the client's preferred pronouns."
(D): "Often, the problem is not a child's gender expression but how those around them react to that expression." | "Often, the problem is not a child's gender expression but how those around them react to that expression." | D | This statement places the context of the problem in the sociocultural response to the client's gender expression without placing blame. Therefore, the correct answer is (C) | counseling skills and interventions |
1,274 | Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual | The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry. Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now. Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices. | You are a counselor in a community mental health agency. The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch. The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.” She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high. | Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.” | Which of the following goals would be the most appropriate overarching goal in working with this client? | Develop sense of empathy for others | Reduce use of alcohol and other substances | Implement mindfulness practices to reduce risk-seeking behaviors | Learn to manage emotions, tolerate distress, and improve relationships | (A): Develop sense of empathy for others
(B): Reduce use of alcohol and other substances
(C): Implement mindfulness practices to reduce risk-seeking behaviors
(D): Learn to manage emotions, tolerate distress, and improve relationships | Learn to manage emotions, tolerate distress, and improve relationships | D | Clients with BPD must learn to manage and tolerate distress as these situations and emotions push them towards frantic, inappropriate behaviors geared to relieving the immediate distress without insight into the consequences of their actions on self and relationships with others. Reducing alcohol and substance use and implementing mindfulness are part of the skills that may be learned through dialectical behavioral therapy (DBT), an evidence-based model for working with BPD. Individuals with BPD do not by nature lack empathy for others, as in the case of the person with a narcissistic personality disorder so this goal would not be typically appropriate for the client with BPD. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,275 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth | Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan. | Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better. | Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time. | What provisional diagnosis would you add to Melanie's chart? | Cannabis Use Disorder | Cannabis Use Disorder, in early remission | Substance Use Disorder | Cannabis Induced Anxiety Disorder | (A): Cannabis Use Disorder
(B): Cannabis Use Disorder, in early remission
(C): Substance Use Disorder
(D): Cannabis Induced Anxiety Disorder | Cannabis Use Disorder | A | Cannabis Use Disorder is the most appropriate and general diagnosis currently, as Melanie meets criteria for this diagnosis to stand alone and separate from her other diagnoses. It has not been determined that Melanie's anxiety was initially caused by use of marijuana; comments in her family history indicate the possibility of anxiety was present before her onset of drug use. The specifier "in early remission" only applies if criteria has not been met within the last three months, and Melanie has only been in treatment for six weeks. The DSM-5 categorizes a variety of substance use disorders separately. If you know the substance being used, it is best to diagnose to that category. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,276 | 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. | Given the client's presenting issues, what would you focus on assessing first? | Family dynamics | Colombian culture | Possibly severe depression | Suicidal/homicidal ideation | (A): Family dynamics
(B): Colombian culture
(C): Possibly severe depression
(D): Suicidal/homicidal ideation | Suicidal/homicidal ideation | D | During the MSE, you noted that the client made homicidal and suicidal statements. In addition, her appearance, affect speech and thought process indicates that she is experiencing significant distress. You must assess this further to determine her risk of homicide and/or suicide. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,277 | 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. | Based on the information provided, which of the following should the counselor suspect for this client? | Major Depressive Disorder (MDD), Attention Deficit Disorder (ADHD) - Inattentive Type | Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic Personality Disorder (NPD) | Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits | Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type | (A): Major Depressive Disorder (MDD), Attention Deficit Disorder (ADHD) - Inattentive Type
(B): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic Personality Disorder (NPD)
(C): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits
(D): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type | Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits | C | The client meets criteria for PDD with a depressed mood most days than not for at least two years (Criterion A). His low self-esteem and feelings of hopelessness meet Criterion B and these have been present for over two years, meeting Criterion C These suggest the client meets criteria for PDD. Additionally, the client meets criteria for ADHD, combined types which is expressed through his forgetfulness, inattention and distraction, and his "need" for active recreation that includes high physical activity and thrill-seeking. The client meets several criteria for NPD, but does not meet the required five or more criteria. He is noted to have a sense of self-importance, though this is observed and not felt by him; he possesses a sense of entitlement that he should have what he wants or desires, even at the expense of others' feelings; he is envious of others, and he has difficulty accessing empathy. These criteria do not meet the full criteria for NPD and because the client possesses insight to understand that these feelings and behaviors are not appropriate, loving, or who he wishes to be, he possesses NPD Traits, not the full personality disorder diagnosis. While he does not meet the full disorder, the trait would be listed in his documentation and be a part of a treatment plan. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,278 | Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 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 general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, "It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now." The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control. | First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the "doctors are missing something" for years. She "feels sick all the time" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the "lack of care" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation. You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career. Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports "battling anhedonia." It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips. You state to the client, "It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?" The client replies, "Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up." You ask the client, "Have people actually said anything to you about your weight?" She responds, "No, but I can tell they're thinking it." As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment. | The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life. She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a "charge nurse." She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition "because those issues run in my family." There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. | How might you use a summarization during this session? | "I see you brought your medical file to session. Let's see if we can find what may be related to your anxiety symptoms." | "We are a week behind in your therapy since you missed your last session. Instead of going over your medical file this week, we need to continue to work on reducing the anxiety you say you are having." | "I see that you are anxious today. Some deep breathing may help you relax and it will be a good way to end this session." | "We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help." | (A): "I see you brought your medical file to session. Let's see if we can find what may be related to your anxiety symptoms."
(B): "We are a week behind in your therapy since you missed your last session. Instead of going over your medical file this week, we need to continue to work on reducing the anxiety you say you are having."
(C): "I see that you are anxious today. Some deep breathing may help you relax and it will be a good way to end this session."
(D): "We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help." | "We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help." | D | Summarizing a session entails briefly discussing how the session started, what issues were brought up, and reminder of any resolution to a problem or homework assigned. This helps you and the client to agree on the general topic of the session and how to proceed in the time between this session and the next one. Therefore, the correct answer is (C) | counseling skills and interventions |
1,279 | 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. Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a "new chance at living." She further discloses that she recently met a "wonderful man." They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that "he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me." She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different. From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. "He's always around when I need him," she explains, "And he listens to me and takes what I say seriously." The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, "If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared." You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts. | 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. | When working with a client who has been diagnosed with Borderline Personality Disorder, which of the following is most likely to be achievable as a short-term goal? | Achieve and maintain healthy boundaries between self and others | Reduce stress, anxiety, and depression | Eliminating self-harming behaviors, rages, and violent outbursts | Significantly improve social functioning and reduce oppositional behavior | (A): Achieve and maintain healthy boundaries between self and others
(B): Reduce stress, anxiety, and depression
(C): Eliminating self-harming behaviors, rages, and violent outbursts
(D): Significantly improve social functioning and reduce oppositional behavior | Reduce stress, anxiety, and depression | B | Reducing stress, anxiety, and depression is typically achievable in the short term. This would involve creating a healthy support network, practicing mindfulness and self-awareness, and identifying emotions driving certain behaviors. Therefore, the correct answer is (A) | treatment planning |
1,280 | 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. | Based on the information provided, which of the following tests will best help determine the client's diagnosis? | Personality Assessment Inventory (PAI) | Beck's Depression Inventory-II (BDI-II) | Minnesota Multiphasic Personality Inventory-2 (MMPI-2) | Rorschach Inkblot Test | (A): Personality Assessment Inventory (PAI)
(B): Beck's Depression Inventory-II (BDI-II)
(C): Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
(D): Rorschach Inkblot Test | Rorschach Inkblot Test | D | The Rorschach Inkblot Test is used to examine personality characteristics and emotional functioning using a complex interpretation and algorithm that is required for accurate analysis of the client's responses. This test would be most helpful in determining the client's diagnosis because it does not require extensive reading or reading comprehension as is needed in long, self-report tests such as the MMPI-2 and the PAI, both of which have over 500 questions. The BDI-II will determine if the client is currently experiencing depression, but will not assess other characteristics or functioning. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,281 | Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency | The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking. | First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, "My son is doing dangerous things to his body. He needs help, but he won't listen to me." The client rolls his eyes and replies, "She doesn't get it. Look at her. She's fat and is always overeating!" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room. Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, "It sounds like your mom is really worried about you." He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps. Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, "I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?" You remain calm and acknowledge the client's frustration. You reply, "You're angry with me because you feel that I'm not listening. Am I hearing you right?" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety. The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but "she just doesn't get how hard it is for me." He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, "It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support. Sixth session It has been one and a half months since you began seeing the client for therapy. He followed up on the referral you gave him to see a psychiatrist and he is currently taking medication for his anxiety, but he reports that "the pills aren't really helping." He says he loves cheerleading and gymnastics and will never give them up. He reports he is still eating and exercising to excess but refuses to stop. He continues, "I'm aware of the dangers, but I don't care. All athletes go through pain to be successful." You assess the client's internal and external motivation as a strategy to separate the client from his denial that he has an illness. | The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying "fatty" or "crispy crème." One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant "as a treat" about four or five times a week. He shares that after these fast food "splurges," he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. | You state, "I hear you saying all athletes go through this to be successful. What does it feel like for you to compare yourself to others?" What skill are you utilizing? | Engaging in constructive confrontation | Providing an encourager | Asking an open-ended question | Asking a close-ended question | (A): Engaging in constructive confrontation
(B): Providing an encourager
(C): Asking an open-ended question
(D): Asking a close-ended question | Asking an open-ended question | C | You are asking the client an open-ended question that elicits how the client feels about others who do this and what this feels like for him. Therefore, the correct answer is (C) | counseling skills and interventions |
1,282 | 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. | 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. | You note some issues in the way the father and son interact with one another. Which would be the least effective way to improve the client's interactional patterns? | Addressing the client's thought patterns and maladaptations contributing to the behavior | Exploring the client's interpersonal behaviors | Showing the client logical consequences | Examining specific relationships | (A): Addressing the client's thought patterns and maladaptations contributing to the behavior
(B): Exploring the client's interpersonal behaviors
(C): Showing the client logical consequences
(D): Examining specific relationships | Showing the client logical consequences | C | In therapy, showing the client logical consequences involves the therapist engaging the client in a conversation geared toward predicting consequences of thoughts, actions, and feelings. The therapist may share his/her view in a non-judgmental manner regarding the pros and cons of a certain situation. This is an influencing skill designed to help clients consider possible consequences of their actions. This will not directly help you improve the client's interactional patterns. Therefore, the correct answer is (D) | counseling skills and interventions |
1,283 | 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 | Kathleen states at the end of the session that they cannot come in because she has a doctor's appointment. Tony states that he could come anyway by himself. How should the counselor respond? | Yes, we can do that | Couples in Marital Counseling can only be seen as a unit | Let me ask my supervisor | Let's talk about if that would be beneficial | (A): Yes, we can do that
(B): Couples in Marital Counseling can only be seen as a unit
(C): Let me ask my supervisor
(D): Let's talk about if that would be beneficial | Let's talk about if that would be beneficial | D | There is no definitive rule that a client can only be seen as a couple in marital counseling. Individuals in the marriage may be seen as well. Counselors should be aware of this and have the appropriate clinical knowledge before seeing part of the couple separately. In determining whether one member of the couple can be seen individually, the counselor should consider the impact it may have on the therapeutic process. Additionally, it is important that ground rules are set prior to the individual session, such as: whatever is said in session will be shared in the next session when both members can attend. Therefore, the correct answer is (C) | counseling skills and interventions |
1,284 | Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School | The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate. | First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents "are the ones who need therapy, not me." She briefly describes the arguments that she claims her parents get into regularly. "They are always going at it, unless thay are at church. Then they act like everything is perfect." When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, "Can you tell me more about your relationship with your boyfriend? How long have you been together?" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a "big fight" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, "I don't know what to do." You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that "it will make it too real." You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several "in-home" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret. While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions. | The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had "high standards and expectations" for everyone in their family. The client says her parents "treat her like a child." She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. "One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up." | In the therapeutic context of the session, the client conveyed a palpable sense of apprehension and unease regarding the disclosure of her pregnancy to her parents, especially given the intricacies of their relationship dynamics. Considering the emotional weight and potential ramifications of her disclosure, what is the best strategy to employ in order to assist her in navigating her fears and anticipations about her parents' possible responses? | Use a guided imagery technique to help the client visualize her and her parents' reactions to her situation | Discuss confidentiality with the client in relationship to her parents' right to know about the pregnancy | Inform the client that as a mandated reporter, you must disclose the pregnancy to her parents | Role play to help the client determine what she might like say to her parents if she decides to tell them | (A): Use a guided imagery technique to help the client visualize her and her parents' reactions to her situation
(B): Discuss confidentiality with the client in relationship to her parents' right to know about the pregnancy
(C): Inform the client that as a mandated reporter, you must disclose the pregnancy to her parents
(D): Role play to help the client determine what she might like say to her parents if she decides to tell them | Role play to help the client determine what she might like say to her parents if she decides to tell them | D | There are various options to consider in terms of involving the client's parents in this case. The least intrusive way may be to role play to help the client figure out what to say to her parents if she decides to tell them about her pregnancy. Therefore, the correct answer is (A) | counseling skills and interventions |
1,285 | Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate | Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam | You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server. | The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment. The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option | The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option. How do you respond? | Discuss the benefits and harms and refer the client to a therapist who provides this treatment. | Encourage the client to seek religious guidance and continue to treat the client. | Discuss the harms of this treatment and continue to treat the client. | Consult a therapist who provides this treatment prior to determining whether a referral is appropriate. | (A): Discuss the benefits and harms and refer the client to a therapist who provides this treatment.
(B): Encourage the client to seek religious guidance and continue to treat the client.
(C): Discuss the harms of this treatment and continue to treat the client.
(D): Consult a therapist who provides this treatment prior to determining whether a referral is appropriate. | Discuss the harms of this treatment and continue to treat the client. | C | The American Counseling Association (ACA) and several other professional organizations have determined that conversion therapy causes harm to patients, and since counselors have an ethical obligation to “do no harm,” they should actively advise clients against it. Despite this, conversion therapy is still legal in most states. The ACA Code of Ethics (2014) requires that “counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others” Referring the client to someone who provides this treatment would be considered unethical in all circumstances, and therefore consulting that therapist to determine referral opportunities would also be inappropriate. Since conversion therapy is a religious-based practice the ACA would hold that encouraging the client to seek religious guidance is a vague suggestion and includes an element of risk. The best option is therefore answer choice D. Therefore, the correct answer is (D) | treatment planning |
1,286 | 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. | 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 assessment tool would help you confirm a diagnosis of Specific Learning Disorder with Impairment in Reading? | Wechsler Preschool and Primary Scale of Intelligence (WPPSI) | Behavior Assessment System for Children (BASC-3) | KeyMath-3 Diagnostic Assessment (KeyMath-3 DA) | Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R) | (A): Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
(B): Behavior Assessment System for Children (BASC-3)
(C): KeyMath-3 Diagnostic Assessment (KeyMath-3 DA)
(D): Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R) | Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R) | D | The WJ-R is used to test cognitive abilities, scholastic aptitude, and achievement in areas such as reading, math, and written language. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,287 | Initial Intake: Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual | Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife. | Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.
History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him. | null | An immediate objective for Theodore should be? | to find housing | to find another way to make meals for himself | to tell his son he doesn't want to live with him | to determine his own goals | (A): to find housing
(B): to find another way to make meals for himself
(C): to tell his son he doesn't want to live with him
(D): to determine his own goals | to determine his own goals | D | Although there are several areas of concern, it is important for the client to make choices for themselves and establish their own goals. By establishing their own goals, this also increases the likelihood of attainability and success. Housing is a priority for Theodore, but it was not stated that this is an emergency. Theodore was able to care for his wife, so he is likely able to care for himself. It is also not an emergency for Theodore to tell his son he doesn't want to live with him. If that is something that Theodore would like to set as a goal, then it can be made a priority. Making meals is a more pressing matter in terms of overall health. However, it is a goal that Theodore should be making for himself. Therefore, the correct answer is (B) | treatment planning |
1,288 | 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. Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly. The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being "too sensitive" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, "You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings." The client says, "I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under. You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way. | 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. | Using a cognitive-behavioral therapy approach, what would be most useful as you begin to teach the couple constructive communication skills? | Psychoeducation on respectful listening | Staying with the feeling | Modeling active listening | Cognitive reframing | (A): Psychoeducation on respectful listening
(B): Staying with the feeling
(C): Modeling active listening
(D): Cognitive reframing | Modeling active listening | C | By demonstrating healthy, productive communication skills and providing the couple with specific examples of what it looks like to actively listen to one another, they can learn how to better communicate and understand each other’s feelings. This will help them build trust in their relationship and work together more effectively when making decisions about managing family responsibilities. Therefore, the correct answer is (D) | counseling skills and interventions |
1,289 | 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. | What should you challenge and need to resolve if the client comes back to therapy? | The client's lack of responsibility for her behavior. | The client's feelings of anger and fear. | The client's concept that you are responsible for the break-up. | Exploring her feeling towards therapy and therapists. | (A): The client's lack of responsibility for her behavior.
(B): The client's feelings of anger and fear.
(C): The client's concept that you are responsible for the break-up.
(D): Exploring her feeling towards therapy and therapists. | The client's concept that you are responsible for the break-up. | C | This is important and central to the current conflict. Calmly challenging the client on this point in future sessions will likely be essential in helping to repair the therapeutic rupture. Therefore, the correct answer is (D) | counseling skills and interventions |
1,290 | Initial Intake: Age: 18 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual | Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
| Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.
History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home. | null | Not feeling pain or having an out of body experience is called? | Disassociation | Displacement | Projection | Hallucination | (A): Disassociation
(B): Displacement
(C): Projection
(D): Hallucination | Disassociation | A | Disassociation is the feeling that you are separated from yourself, which often happens when someone experiences a very painful or traumatic event. Displacement is a defense mechanism in which a negative emotion is redirected to a less threatening object. Projection is a defense mechanism in which feelings are placed onto another object or person. Hallucinations are experiences that are not real and are created by your mind. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,291 | Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School | The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported. | First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom. Logan has been refusing to go to school, saying he has stomach aches. His mother says, "He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just "kids being kids" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school. During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience. As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself. Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions. Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he "won't ever go to school again," and "hopes those boys die." As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is "worthless" and "deserves the bullying" because he is not "cool" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated. You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress. In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty. When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be "cool" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school. Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings. | The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family. | What steps can you take to address the client's continued discouragement despite therapy? | Show support and use active listening skills. | Remember that discouragement is part of the process, allowing him to work through his feelings and find his own way. | Meet with the client more frequently. | Assign homework exercises to practice the coping skills you are teaching. | (A): Show support and use active listening skills.
(B): Remember that discouragement is part of the process, allowing him to work through his feelings and find his own way.
(C): Meet with the client more frequently.
(D): Assign homework exercises to practice the coping skills you are teaching. | Show support and use active listening skills. | A | Even though you might be delivering helping the client, it appears as though he is still struggling with his emotions and what he should do. Don't overlook the importance of being where the client is in the process. Don't get ahead of them if they need more time to process what they feel. Therefore, the correct answer is (B) | counseling skills and interventions |
1,292 | Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual | Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness. | Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams. | Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities. | What elements are generally included in a CBT Thought Record? | event, automatic thoughts, underlying core beliefs, new core beliefs | trigger, thought, feeling, reason, desired thought, desired feeling | trigger, feelings, underlying core beliefs, desired core beliefs, new feelings | event, emotion rating, thought, challenging thoughts, new thought, new emotion rating | (A): event, automatic thoughts, underlying core beliefs, new core beliefs
(B): trigger, thought, feeling, reason, desired thought, desired feeling
(C): trigger, feelings, underlying core beliefs, desired core beliefs, new feelings
(D): event, emotion rating, thought, challenging thoughts, new thought, new emotion rating | event, emotion rating, thought, challenging thoughts, new thought, new emotion rating | D | Cognitive Behavioral therapy "thought records" walk clients through what event occurred that caused negative emotional states and negative automatic thoughts. Through examining these connections and after a client gives a rating to each emotion, you then help them reality test and challenge the thoughts they had - attempting to get them to provide evidence in support of or against their original thoughts. This processing technique is intended to train their minds to automatically challenge "negative automatic thoughts" in effort at reducing negative emotional states. Any of the above elements would be helpful as part of an exercise or follow-up activity looking at underlying core beliefs, but the goal of a thought record is to address here and now automatic responses. Therefore, the correct answer is (B) | counseling skills and interventions |
1,293 | Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center | The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments. | First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee "thunder thighs over there needs to get her act together!" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it "all come crashing down" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment. You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy "since that stuff makes you fat." When you ask her to describe what she eats during a typical day, she says, "I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner." When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, "The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising." As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as "less-than" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image. You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, "I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat." You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food. | The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but "my stepfather is a different story." She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, "I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health." Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels "on edge," and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row. | What is most important when assembling a team to help the client? | Educating the client in managing her eating patterns | Communicating with members of the client's treatment team | Ensuring necessary medical care while preventing self-harm | Ensuring that the treatment team follows through with their care | (A): Educating the client in managing her eating patterns
(B): Communicating with members of the client's treatment team
(C): Ensuring necessary medical care while preventing self-harm
(D): Ensuring that the treatment team follows through with their care | Ensuring necessary medical care while preventing self-harm | C | Medical care while preventing self-harm include imposed treatment, enforced feeding, the duty to protect minors and adults, the determination of competence and capacity among medically comprised clients, and the effectiveness of coercive treatment for clients with eating disorders. Therefore, the correct answer is (B) | professional practice and ethics |
1,294 | 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 of the following is LEAST likely to be a long-term effect of this client’s trauma if left untreated? | Difficulty with trust | Adjustment disorder | Clinical depression or anxiety | Difficulty with intimacy | (A): Difficulty with trust
(B): Adjustment disorder
(C): Clinical depression or anxiety
(D): Difficulty with intimacy | Adjustment disorder | B | Adjustment disorders arise in reaction to major events or life changes that disrupt an individual’s prior way of life. These events may be positive or negative in nature. Common causes include the divorce of parents, moving to a new home/state/school, marriage, having children, loss of a job, loss of a loved one, or retirement. Although an adjustment disorder may be peripherally linked to stress from trauma or retraumatization, it is the least likely of all of the options to result from sexual trauma (post-traumatic stress disorder would be more likely). Intimacy and trust might be difficult for the client in the future because they are directly related to the sexual assault. Depression and anxiety symptoms are already present and may progress to clinical levels if untreated. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,295 | 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.” | You ask Lottie if she feels safe at home. She replies, "I'm not answering that, I could get in trouble." How should you proceed? | Ask her why she would get in trouble. | Call department of family services and file a report. | Conduct the Child Safety Self-Report Checklist. | Use motivational interviewing. | (A): Ask her why she would get in trouble.
(B): Call department of family services and file a report.
(C): Conduct the Child Safety Self-Report Checklist.
(D): Use motivational interviewing. | Ask her why she would get in trouble. | A | Furthering this conversation to obtain as much information as possible from Lottie can better inform your next step decisions. You cannot file a report without more information about alleged abuse or neglect. There is no official document called the "Child safety self-report checklist" although you can run through checklist items with her if she is willing to answer them. This can be accomplished through one-at-a-time questions in casual conversation, which seem to be most effective with Lottie. Motivational interviewing does not yet apply here but may be useful soon depending on the rest of the conversation. Therefore, the correct answer is (D) | counseling skills and interventions |
1,296 | Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice | The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature. The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation. | First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are "roommates" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome. | The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps "take the edge off." The client states he would rather deal with the pain than be emotionally blunted. | As part of your continuing education, you have elected to use this case as an exemplar. What is your next step? | Remove the personal information from the record to obviate consent | Set aside a therapy session to explore the legalities of record use in depth | Explain to the clients why their case can serve as an exemplar | Obtain informed consent from both clients concerning their records | (A): Remove the personal information from the record to obviate consent
(B): Set aside a therapy session to explore the legalities of record use in depth
(C): Explain to the clients why their case can serve as an exemplar
(D): Obtain informed consent from both clients concerning their records | Obtain informed consent from both clients concerning their records | D | The clients must be asked to consent before their data can be shared. Therefore, the correct answer is (D) | professional practice and ethics |
1,297 | 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. Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, "I've had enough of you today! This time, I'm going to talk!" Gregory rolls his eyes and mocks her. According to his mother, Gregory was "caught by the school resource officer today with a vape on him." She chokes back tears, saying, "I don't know who my son is anymore." Gregory responds, "You're overreacting. That's all you do. Big deal. It's just a vape. Get over it." His mother looks at you and says, "He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?" Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him. 10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals. Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, "Good, I guess." You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, "Why are you upset after being successful with your exam?" He shrugs his shoulders, looks at you, says, "Would you stop asking me so many questions?" and walks out of the office. You follow him into the waiting room and hear him tell his mom, "I'll be in the car." His mom looks confused. You say to her, "Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades." She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today. | 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. | Gregory needs to use telehealth for the next week. What would be your priority regarding the use of this technology? | Determine if the client is in danger of harming themselves or someone else | Instruct the client regarding technology protocols | Maintain client confidentiality | Provide age an appropriate means of telecommunication for the client | (A): Determine if the client is in danger of harming themselves or someone else
(B): Instruct the client regarding technology protocols
(C): Maintain client confidentiality
(D): Provide age an appropriate means of telecommunication for the client | Maintain client confidentiality | C | Confidentiality would be the most important consideration regarding distance therapeutic services. Trust is the cornerstone of the therapeutic relationship and is critical regarding any therapy delivery methodology you use. The therapist must ensure that the telehealth sessions mimic an in-person session regarding client confidentiality. Therefore, the correct answer is (A) | professional practice and ethics |
1,298 | Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual | Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
| Michael came to the counselor’s office after he was suspended for fighting with one of the other students.
History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before. | null | The counselor should gather information on? | How long Michael will be suspended | How Michael's teacher reacted | What triggered the fight | What punishment the other student received | (A): How long Michael will be suspended
(B): How Michael's teacher reacted
(C): What triggered the fight
(D): What punishment the other student received | What triggered the fight | C | It is important for the counselor to understand what triggered the fight, especially since it is out of character for Michael. The length of time that Michael will be suspended as well and the ramifications that the other student had are not relevant to understanding Michael's symptoms. Knowing how Michael's teacher reacted may be important if she was not supportive of him, but there is no indication of that currently. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,299 | 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 client's current presentation in this session and the information he shared, which of the following goals would be most effective to focus on for this session? | 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 | Client will experience no suicidal ideation or thoughts of self-harm | (A): Client will obtain employment to meet his needs for independence
(B): Client will develop a support system to meet his needs for community and support
(C): Client will experience reduction in depression and anxiety
(D): Client will experience no suicidal ideation or thoughts of self-harm | Client will develop a support system to meet his needs for community and support | B | As the client has presented with improvement in his emotional well-being and employment circumstances, and is focused on a lack of friendships, it will be most effective to focus on the goal of developing a support system to meet his needs for a social community. The client, with the help of medication, has begun reducing his depression, though he presents as anxious about meeting new people. Focusing on developing a support system will help reduce this anxiety, while providing a support community. The client has met his goal for employment and the counselor should continue to monitor this with the client to ensure that he is progressing towards independence. The client reported no thoughts of suicide or self-harm at this time and the counselor and client will just continue to monitor this goal. Therefore, the correct answer is (D) | counseling skills and interventions |
1,300 | 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. | 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. | Which of the following statements taken by themselves is most indicative of a diagnosis of Separation Anxiety Disorder? | The client is exhibiting symptoms of repetitive behaviors. | The client has experienced a major life change. | The client is more talkative than usual and is easily distracted. | The client is resistant to going to the store or to school. | (A): The client is exhibiting symptoms of repetitive behaviors.
(B): The client has experienced a major life change.
(C): The client is more talkative than usual and is easily distracted.
(D): The client is resistant to going to the store or to school. | The client has experienced a major life change. | B | Separation Anxiety Disorder is often precipitated by a significant life change such as moving, the death of a loved one, divorce, or becoming a parent. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
Subsets and Splits