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1,301 | Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography | You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues. | The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences | Which of the following is the most accurate definition of mindfulness? | Meditation focused on being aware of thoughts and feelings and interpreting what those thoughts and feelings mean to you | Being aware of how you feel in the moment and then engaging that awareness through the use of cognitive reframing | Using deep breathing, progressive muscle relaxation, and radical acceptance of how you feel and what you are thinking | Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing | (A): Meditation focused on being aware of thoughts and feelings and interpreting what those thoughts and feelings mean to you
(B): Being aware of how you feel in the moment and then engaging that awareness through the use of cognitive reframing
(C): Using deep breathing, progressive muscle relaxation, and radical acceptance of how you feel and what you are thinking
(D): Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing | Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing | D | The best definition of mindfulness includes meditation that involves being aware of thoughts and feelings with no judgment or interpretation and that involves grounding techniques. The goal of mindfulness is to be completely present in your body and to be aware of thoughts and feelings but not to engage in them. Interpretation or radical acceptance of thoughts and feelings would likely escalate thoughts and feelings because they were already distressing for the client. Just controlling cognitions or just controlling the body’s response to a situation does not completely support the definition of mindfulness. Therefore, the correct answer is (C) | counseling skills and interventions |
1,302 | Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual | The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene. Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else. | You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help. | Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town. | Given the information presented, which of the following interventions will be most beneficial to help the client understand her hoarding? | Ask client to choose one item a day to discard | Utilize the "empty chair" to explore relationships that have been replaced by possessions | Have the client bring a small box of her possessions to session for therapeutic exploration | Have the client choose an item in her home at random and journal about its value to her | (A): Ask client to choose one item a day to discard
(B): Utilize the "empty chair" to explore relationships that have been replaced by possessions
(C): Have the client bring a small box of her possessions to session for therapeutic exploration
(D): Have the client choose an item in her home at random and journal about its value to her | Have the client bring a small box of her possessions to session for therapeutic exploration | C | Common features in hoarding disorders include difficulty making decisions, trouble organizing, procrastination, avoidance, and using objects as replacements for relationships. Having the client bring a small collection of items to session so that the client and counselor can explore the client's emotions and thought processes surrounding items that have little value but take up space in her home. The empty chair exercise is a helpful intervention to help clients explore relationships. This client has demonstrated limited insight about her hoarding, making an empty chair exercise difficult. Given the client's limited insight into her hoarding, she is not likely to follow through with journaling or find it helpful. Asking the client to discard one item a day is not an effective treatment for hoarding disorder as the difficulty in making decisions about what should go or stay is part of the disorder. Therefore, the correct answer is (A) | treatment planning |
1,303 | Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy. Behavior: The client's overall behavior is withdrawn. Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat. Speech: His speech is both slowed and measured. Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating. Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances. Orientation: The client is oriented to person, place, and time. Insight: It appears that the client has poor insight into his condition. Attitude: His attitude towards the evaluator is compliant and cooperative. | First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt "down in the dumps" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that "no one wants me around." Then he looks down and says, "I don't really blame them. I wouldn't want to be around me either." At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have "not been close for a long time now." They both sleep in separate bedrooms and they lead separate lives. He explains, "We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody." After the client has shared why he is seeking counseling, you state, "I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing." You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, "I'd feel better, I guess." You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, "Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect." You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week. Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, "My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision." You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week. Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, "I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again." You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, ""I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them." You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment. | The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, "I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but "my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much." Despite this difficulty in connecting, the client has an adult daughter whom he "loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, "I don't want her to think the same way I do about family and relationships. I want her to have good ones." The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of "dealing with both the inmates and the administration." He tells you his co-workers consider him a "slacker" because he is always tired and takes as many breaks as he can get away with. He is also worried about "word getting back to his co-workers" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey. | You have been asked to publicly comment on a bill pending in your state legislature that would make clinical depression eligible for medical leave. What is your ethical responsibility? | Your ethical responsibility is to publicly remain neutral in order to not influence future clients. | You have no ethical responsibility to weigh in on a matter of public debate. | Your ethical responsibility is to not participate in contentious public debates. | Your ethical responsibility is to advocate for this as an advancement of client care. | (A): Your ethical responsibility is to publicly remain neutral in order to not influence future clients.
(B): You have no ethical responsibility to weigh in on a matter of public debate.
(C): Your ethical responsibility is to not participate in contentious public debates.
(D): Your ethical responsibility is to advocate for this as an advancement of client care. | Your ethical responsibility is to advocate for this as an advancement of client care. | D | One of the ethical responsibilities as a therapist is to advocate for client issues. Therefore, the correct answer is (A) | professional practice and ethics |
1,304 | 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. To help the client identify treatment plan goals, you ask him to envision what it would be like if he woke up one day and a miracle had occurred—a miracle that caused his problem to cease to exist | To help the client identify treatment plan goals, you ask him to envision what it would be like if he woke up one day and a miracle had occurred—a miracle that caused his problem to cease to exist. Which therapy approach does this reflect? | Gestalt therapy | Motivational enhancement therapy | Client-centered therapy | Solution-focused brief therapy | (A): Gestalt therapy
(B): Motivational enhancement therapy
(C): Client-centered therapy
(D): Solution-focused brief therapy | Solution-focused brief therapy | D | Solution-Focused Brief Therapy (SFBT) is a short-term, solution-oriented best practice used to help clients establish and reach goals by improving motivation and creating measurable behavioral change. The Miracle Question is an SFBT technique that encourages the client to envision a future without the problem. The client is then asked to provide details of what is pictured, enabling you to partner with the client to form manageable and attainable treatment planning goals. Gestalt therapy is based on developing a here-and-now awareness. Client-centered therapy emphasizes attaining congruence between one’s ideal self and actual self. Motivational Enhancement Therapy emphasizes increasing change talk to reduce ambivalence. Therefore, the correct answer is (C) | counseling skills and interventions |
1,305 | 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. | The client receives psychoeducation on various treatment interventions for agoraphobia. She understands the risks and benefits, and you review informed consent each session. The client would like to work on her fear of stairs first, which is less anxiety-provoking than elevators. She expresses an understanding of exposure exercises and is willing to give them a try. You and the client use a Subjective Units of Distress Scale (SUDs) to measure the intensity of each anxiety-provoking situation, which can range from 0 units (no distress) to 100 units (extreme distress). Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors | Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors. The theoretical framework for CART is based on which of the following assumptions? | Muscle tension resulting from anxiety and panic can be treated with progressive relaxation and deep breathing. | Drops in body temperature resulting from anxiety and panic can serve as an alert to start using coping strategies and deep breathing. | Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control. | Increased heart rate resulting from anxiety and panic can be altered with autogenic relaxation and mindfulness meditation. | (A): Muscle tension resulting from anxiety and panic can be treated with progressive relaxation and deep breathing.
(B): Drops in body temperature resulting from anxiety and panic can serve as an alert to start using coping strategies and deep breathing.
(C): Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.
(D): Increased heart rate resulting from anxiety and panic can be altered with autogenic relaxation and mindfulness meditation. | Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control. | C | The framework for CART assumes that low levels of carbon dioxide resulting from symptoms of anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control. The CART approach measures PaCO2and respiration rates believed to be the primary or secondary causes of anxiety and panic. Individuals are instructed to breathe in ways that prevent hyperventilation. This is achieved by taking slow, shallow breaths. CART is based on the theory that deep breaths, such as those used in relaxation training, can induce hyperventilation, leading to increased fear and panic. Progressive relaxation, thermal biofeedback, and mindfulness meditation are also effective in reducing anxiety but do not attribute therapeutic change to increased levels of PaCO2. Therefore, the correct answer is (D) | counseling skills and interventions |
1,306 | 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. | Based on the information provided, which assessment would be most helpful at this time? | An attachment style assessment | A genogram | A family session for observation | Yale-Brown Obsessive Compulsive Symptoms Inventory (Y-BOCS) | (A): An attachment style assessment
(B): A genogram
(C): A family session for observation
(D): Yale-Brown Obsessive Compulsive Symptoms Inventory (Y-BOCS) | A genogram | B | A genogram will provide a pictorial map of the client's nuclear and extended family and the patterns and relationships between them. Often genograms can include significant others with whom the client frequently interacts so these relationships can also be examined. The genogram will help the client and counselor examine how the client interacts with others and patterns that may be helpful or unhelpful for him. A history of OCPD behaviors will show up in a genogram as the counselor and client explore patterns of interacting with others. An attachment style assessment will help the counselor understand the client's experience with early primary caregivers and how that relationship may be replicated in his romantic relationship with his wife. This is helpful information but does not provide the breadth of material that a genogram will provide based on the client's difficulties relating to others including his wife, stepchildren, employees, and friends. The Y-BOCS is an assessment for OCD, while this client shows more affinity towards traits of OCPD (preoccupation with details, rules, order, and organization; perfectionism; excessive devotion to work to the exclusion of leisure activity). A family session for observation would not be helpful in building therapeutic rapport as the family focus would likely be on describing how the client's behaviors make the family feel that they cannot meet his expectations. A family or couple session may be more helpful once treatment has begun to help provide a supportive environment for the client while he attempts to make changes. Therefore, the correct answer is (B) | counseling skills and interventions |
1,307 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Engaged Counseling Setting: Agency - Telehealth Type of Counseling: Individual | Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago. | Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9)
You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability. | Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him. | Which counseling strategy is the best for addressing the client's family issues and relationship with her mother? | FFT | MI and DBT techniques to help her gain insight | Provide active listening, validate of her feelings, and introduce her to REBT | Recommending a 12 Step program for codependency and providing resources in her area | (A): FFT
(B): MI and DBT techniques to help her gain insight
(C): Provide active listening, validate of her feelings, and introduce her to REBT
(D): Recommending a 12 Step program for codependency and providing resources in her area | Provide active listening, validate of her feelings, and introduce her to REBT | C | In this early phase of getting to know your client, you are still working to gain rapport and trust. Lacking history of counseling with this client and without further clarification of her issues, MI (motivational interviewing) and DBT (dialectical behavioral therapy) are too confrontational. Validation of feeling has been regarded as one of the best ways to illicit a positive response from your client and gain their engagement, and REBT (rational emotive behavioral therapy) is an excellent choice within Cognitive Behavioral Therapy interventions to begin to help the client address her beliefs that are affecting her emotions rather than focusing on other people or events that have occurred. REBT's key tenets involve acceptance of self and others while learning how to challenge cognitive distortions affecting moods and behaviors. Regarding answer a), the scenario does not identify codependency as an issue despite the potential a counselor may consider it exists. Answer a) further involves recommending treatment for character deficits that she has not yet self-identified with you in counseling, nor has she yet requested for any outside support. Support groups are also an unrealistic option to consider since she is evidently already struggling with one online session let alone a long-term, in-person commitment. FFT (family functional therapy) is an intensive, short-term program providing in-home family counseling to address juvenile delinquency and is therefore not appropriate. Therefore, the correct answer is (B) | counseling skills and interventions |
1,308 | 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. | After speaking with the client, you worry that your values do not appear to align with the client's father's values. To avoid value imposition in your joint session, which of the following core counseling skills should you be prepared to use? | Bracketing | Authenticity | Resistance | Congruence | (A): Bracketing
(B): Authenticity
(C): Resistance
(D): Congruence | Bracketing | A | Holding your own values internally and not allowing them to impact your work with the client and her father will be paramount. Therefore, the correct answer is (D) | counseling skills and interventions |
1,309 | 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. | At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home in a few years.” You ask how she feels about living with her mother again, and she says she does not want to be with her because her mother does not want to be with her. You try to process this with the client, and she says that she likes her house and her school and does not want to leave. You meet with the foster parents and the client at the end of the session, and they report that spending quality time with the client on a daily basis has been helpful in improving their relationship. They state that they think they had been too afraid to overwhelm her and that at times they were trying to give her space, but they realize that the intentional time together has been helpful. You empathize with the foster parents and encourage them to continue to spend quality family time with her | Which one of the following attachment styles best defines the client’s relationship with her foster parents? | Disorganized/fearful | Ambivalent/preoccupied | Avoidant/dismissive | Secure | (A): Disorganized/fearful
(B): Ambivalent/preoccupied
(C): Avoidant/dismissive
(D): Secure | Disorganized/fearful | A | The client’s behavior is characterized by heightened anxiety, increased irritability, and distance from others, which comprises a disorganized or fearful attachment style. A secure attachment style is when a child feels comfortable enough to communicate wants and needs, knows that their caregiver has their interest and safety in mind, is independent, and has good self-esteem. An avoidant, or dismissive, attachment style is characterized by insecurity, independence, a desire for intimacy but a fear of it, and the placement of distance between the self and others. An individual demonstrating an ambivalent or preoccupied attachment style focuses intensely on having relationships with others and feels very insecure when he or she does have a relationship because of a fear that the relationship will end. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,310 | 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 is the first step you should take in response to the client's statements about the bullies during today's session? | Identify ways for Logan to cope with his intense feelings | Create a safety plan with Logan | Reiterate you are a mandated reporter, and what he divulges has consequences | Explore Logan's feelings of anger and assess risk of harm | (A): Identify ways for Logan to cope with his intense feelings
(B): Create a safety plan with Logan
(C): Reiterate you are a mandated reporter, and what he divulges has consequences
(D): Explore Logan's feelings of anger and assess risk of harm | Explore Logan's feelings of anger and assess risk of harm | D | When clients express violent thoughts towards others, exploring their feelings and why they are experiencing them is crucial. This will help to determine if the client is a danger to themselves or others and if they need further intervention. Therefore, the correct answer is (C) | counseling skills and interventions |
1,311 | Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency | Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age. Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport. Speech: Speech volume is normal, and speech flow is normal and spontaneous. Mood: The client's mood is dysphoric and anxious. Thought Process: Thought process is logical. Thoughts are negative. Affect: The client's affect is broad and appropriate to the discussion. Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment. Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average. | First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting. At the end of the session, the client turns to her husband and says, "I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him." Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner. Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, "He called twice last week, but I didn't answer. At least someone wants to talk with me!" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, "See? That's all I ever get! Nothing!" and begins to cry. Dale seems angry but remains quiet. Dale sighs and rubs his temples. "This is why I don't talk about it," he says. "You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?" Ruth sniffs and wipes her eyes. "Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you." Dale rolls his eyes. "That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen." Ruth bristles, tears streaming down her face. "Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?" Dale throws his hands and walks away in frustration. "I don't know, Ruth. I really don't know." | Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is "on the rocks.'" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, "I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do." | Which is not one of the communication styles Gottman identifies as The Four Horsemen in conflict discussions for couples? | Contempt | Stonewalling | Defensiveness | Complaint | (A): Contempt
(B): Stonewalling
(C): Defensiveness
(D): Complaint | Complaint | D | Voicing a complaint is different from criticizing your partner. This is not one of the four horsemen identified by Gottman. A complaint indicates the reason you are upset with your partner. (eg, "I was worried when you were running late and did not call me. I thought we agreed to do that for each other"). Therefore, the correct answer is (A) | counseling skills and interventions |
1,312 | 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 | In DBT, all of the following are main focuses of therapy, EXCEPT: | Distress tolerance | Emotional regulation | Mindfulness | Systematic desensitization | (A): Distress tolerance
(B): Emotional regulation
(C): Mindfulness
(D): Systematic desensitization | Systematic desensitization | D | Systematic desensitization is an intervention that uses aspects of CBT and applied behavioral analysis; it is not a DBT technique. Systematic desensitization focuses on progressive exposure to greater anxiety-inducing stimuli coupled with relaxation techniques. Mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness are the four focuses of DBT in improving life skills. Mindfulness focuses on becoming more aware of oneself and being present in the moment. Emotional regulation focuses on identifying, labeling, and addressing certain emotions. Distress tolerance focuses on experiencing strong emotions and not reacting impulsively or destructively. Therefore, the correct answer is (D) | counseling skills and interventions |
1,313 | Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual | Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings. | Diagnosis: Acute Stress Reaction (F43.0), Provisional
You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established. | Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father. | Maria discontinues counseling. Whom should you inform? | The grandmother and the school | Just her grandmother | Just the school | You do not need to inform anyone | (A): The grandmother and the school
(B): Just her grandmother
(C): Just the school
(D): You do not need to inform anyone | The grandmother and the school | A | If a minor discontinues treatment against clinical advice and there are consent to release information forms signed with her guardian and school, it is best practice for the child's safety to let them know that their grandchild or their student will no longer be engaged in counseling/discharged, although there may be no law mandating you do so. No further information is needed, however, a thoughtful and safety-minded counselor would advise that they be recontacted for continued care if there is evidence of need, if the client requests it, or if they are in a deteriorated or crisis state. You should also check with your agency's policies, school's expectations or state laws. Therefore, the correct answer is (C) | professional practice and ethics |
1,314 | 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 | Based on the first session notes, Carlos is showing symptoms of? | Bipolar Disorder | Antisocial Personality Disorder | Avoidant personality Disorder | Conduct Disorder | (A): Bipolar Disorder
(B): Antisocial Personality Disorder
(C): Avoidant personality Disorder
(D): Conduct Disorder | Conduct Disorder | D | Carlos meets the criteria for conduct disorder because of the following symptoms: initiating physical fights, bullying others, destruction of property, breaking into cars and school truancy. Carlos does not display episodes of mania (elation, self-importance, irritated or agitated) or depression (feelings of sadness, pessimism, hopelessness, difficulty sleeping or concentrating). The minimum age for antisocial personality disorder is 18. Avoidant personality is characterized by social inhibition due to feelings of inadequacy, fear of being ridiculed or hypersensitivity to criticism. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,315 | Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0) | Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th | You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species. | The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.” During the last group session, a member stated, “I didn’t know there were other people on campus that viewed things in the same way that I do | During the last group session, a member stated, “I didn’t know there were other people on campus that viewed things in the same way that I do.” This is an example of which one of the following? | Transference | Altruism | Catharsis | Universality | (A): Transference
(B): Altruism
(C): Catharsis
(D): Universality | Universality | D | This member’s statement is an example of universality (one of Irvin Yalom’s curative factors), which is the feeling that one receives when connecting with others. Group members learning that others who live on campus share similar viewpoints will likely reduce isolation, which is a by-product of universality. Catharsis is a psychodynamic term referring to the emotional release of previously repressed energy tied to a traumatic event. Transference is a Freudian concept that describes the redirection of a repressed emotion onto another person. Altruism is another one of Yalom’s curative factors regarding group members learning to help others. Therefore, the correct answer is (D) | counseling skills and interventions |
1,316 | Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual | The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. | You are a counselor in a community agency that provides counseling. Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help. She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.” | Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions. | Which of the following would be the best intervention at this time? | "It seemed like it was hard for you to connect what happened in your life to your feelings about yourself." | "That's a big story, where do you want us to start?" | "Can you tell me about your time in jail and how that changed you?" | "You showed your parents that you weren't 'the good girl' anymore." | (A): "It seemed like it was hard for you to connect what happened in your life to your feelings about yourself."
(B): "That's a big story, where do you want us to start?"
(C): "Can you tell me about your time in jail and how that changed you?"
(D): "You showed your parents that you weren't 'the good girl' anymore." | "It seemed like it was hard for you to connect what happened in your life to your feelings about yourself." | A | The client has provided lots of content but had difficulty connecting to herself in the story, as demonstrated by her pauses, when the counselor asked about feelings, and then moving back into content. Individuals with a fragile self-esteem or sense of identity (ie, such as narcissists) have difficulty with insight into their own emotions. Making an observation of what the counselor is observing opens up an opportunity to begin processing emotions with the content. Asking the client to determine where to start allows the client to direct the session, but if the client is struggling with connecting to emotions, the client will be more likely to stay content-focused rather than working therapeutically on process. Making a statement about the client not being "the good girl" anymore would likely be received as sarcasm or judgement about the client's actions, rather than listening for the emotions and thoughts underneath the content. Asking about how jail changed her is a good question but if it is asked right now, it changes focus away from the content and difficulty with emotional connection that the client has just demonstrated. It is best to work with the client where they are when there is a therapeutic opening, rather than redirecting to new content. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,317 | 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. | 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. | When would you breach confidentiality as a therapist? | The client is watching pornography on one of the school's computers. | The client tells you he is smoking marijuana with his friends on the weekends. | The client tells you he wants to hurt the bullies from his school. | The client says he is going to a fast-food restaurant and eat twelve burgers all in one sitting. | (A): The client is watching pornography on one of the school's computers.
(B): The client tells you he is smoking marijuana with his friends on the weekends.
(C): The client tells you he wants to hurt the bullies from his school.
(D): The client says he is going to a fast-food restaurant and eat twelve burgers all in one sitting. | The client tells you he wants to hurt the bullies from his school. | C | Harm to self and others is a reason to breach confidentiality. Therefore, the correct answer is (D) | professional practice and ethics |
1,318 | 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. Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a "sissy boy." He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to "be on his side" when his father berates him. He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in. Tenth session The family arrives to today's session to review Andie's progress. The mother states that she is happy to see that the conflict between her husband and son is decreasing. She states that they are all utilizing "I statements" in order to express their feelings. The father states that he is trying to just let him go through this "phase" and find himself. You continue to explore with the family any other contributing factors that could be hindering family dynamics. You also explore an array of interventions that would be appropriate when behavior disturbances occur. | 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. | In diagnosing a client with Gender Dysphoria in Children, how long must the symptoms be present, and how many symptoms must be exhibited? | At least one year manifested in at least four symptoms | At least one year manifested in at least seven symptoms | At least six months manifested in at least six symptoms | At least three months manifested in at least five symptoms | (A): At least one year manifested in at least four symptoms
(B): At least one year manifested in at least seven symptoms
(C): At least six months manifested in at least six symptoms
(D): At least three months manifested in at least five symptoms | At least six months manifested in at least six symptoms | C | To diagnose Gender Dysphoria in Children, there must be a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least six symptoms. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,319 | Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency | The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, "Everyone overreacts these days." He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices. | First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse. After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues. Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand. When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have "one drink." He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed. Seventh session The client's attendance in weekly therapy sessions has been inconsistent. Today, he presents to his scheduled session, and he hands you a discharge summary from another recent hospitalization. The client states that he was on one of his "highs," went to a bar, and ended up fighting with one of the other customers. He says he has no recollection of how the fight started, but the person he was fighting with told him that "his life was useless and that he would be better off dead." The client states that having a few drinks and driving around in his car while listening to music helps him calm down. You validate the client's attempts to identify coping skills. The client's depression is further evidenced by his lack of motivation and interest in activities he once found enjoyable. He reports feeling overwhelming hopelessness and expresses a pervasive feeling of worthlessness. His low self-esteem is apparent in his statements and is further evidenced by his inability to recall accurately the events leading up to the altercation. The client's risk for self-harm is elevated, given his recent suicidal ideation. He reports feeling his life has no value and that he would be better off dead. His current safety plan is inadequate to address his risk for self-harm and is further exacerbated by his use of alcohol as a coping mechanism. The client has little insight into his current mental state and cannot accurately identify the signs of his deteriorating mental health. He lacks insight into his coping skills and their potential consequences and is unable to recognize the need for more comprehensive safety planning | The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since. The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, "I started drinking years ago. I've tried to quit, but I can't do it." He further states, "It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped." | What would be the most beneficial referral for the client? | Readmission to inpatient with referral to the discharge plan case manager | Readmission to inpatient with referral to an Outpatient Program | Readmission to inpatient with referral to Residential Treatment Program | Readmission to inpatient with referral to Partial Hospital Program | (A): Readmission to inpatient with referral to the discharge plan case manager
(B): Readmission to inpatient with referral to an Outpatient Program
(C): Readmission to inpatient with referral to Residential Treatment Program
(D): Readmission to inpatient with referral to Partial Hospital Program | Readmission to inpatient with referral to Residential Treatment Program | C | The client continues to pose a threat to himself and others with his continued drinking and driving while intoxicated. Therefore, immediate placement in a residential treatment program would be most beneficial for his safety at this time. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,320 | Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5) | Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam | You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns. | ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining | Which diagnostic feature of OCPD tends to cause difficulties with close relationships? | They must constantly adjust their expectations when perfectionistic standards are not met. | They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism. | They possess ego-dystonic personality traits that are pervasive and less amenable to change. | They disregard family activities and believe leisure time should be an individual pursuit. | (A): They must constantly adjust their expectations when perfectionistic standards are not met.
(B): They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.
(C): They possess ego-dystonic personality traits that are pervasive and less amenable to change.
(D): They disregard family activities and believe leisure time should be an individual pursuit. | They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism. | B | According to the DSM-5-TR features include a preoccupation with rules and details, perfectionism that interferes with progress, excessive devotion to work, counterproductive rigidity about beliefs and morality, an inability to throw away old objects, reluctance to delegate authority to others, rigidity or stubbornness, and hoarding money without spending. Individuals with OCPD possess ego-syntonic traits rather than ego-dystonic traits. Individuals with ego-syntonic features are less amenable to change because there is little to no desire to change. Conversely, individuals with obsessive-compulsive disorder (OCD) have ego-dystonic traits, meaning they experience dissatisfaction with symptoms and desire change. Per the DSM-5, individuals with OCPD “are rigidly deferential to authority and rules and insist on quite literal compliance, with no rule bending for extenuating circumstances” Strict adherence to rules and authority persists despite personal distress while attempting to attain perfection. Leisurely activities are generally forfeited by prioritizing productivity and work. Solo vacations and vacations with others may be postponed, and when they do occur, they are highly structured in an effort to not waste time. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,321 | Initial Intake: Age: 26 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
| Molly came into individual counseling due to increased feelings of anxiety.
History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university. She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career. | null | Cognitive behavioral therapy does not include? | Empty chair technique | Behavioral experiments | Deep muscle relaxation | Cognitive restructuring | (A): Empty chair technique
(B): Behavioral experiments
(C): Deep muscle relaxation
(D): Cognitive restructuring | Empty chair technique | A | The empty chair technique is a Gestalt method in which an empty chair is used so the client can express themselves to a "person" unavailable to them. Deep muscle relaxation is a progressive tightening and loosening of muscles which allows the person to relax muscles they may not have realized were tense. Cognitive restructuring is a CBT method where someone identifies their irrational thoughts and replaces them with more realistic and productive ones. Behavioral experiments are used often in CBT for someone to test their catastrophic thinking so they can see whether what they fear the most occurs. Therefore, the correct answer is (C) | professional practice and ethics |
1,322 | 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 | At this point in treatment, which of the following assessments would be clinically appropriate to use with the couple? | Beck Anxiety Inventory | Dyadic Adjustment Scale | Minnesota Multiphasic Personality Inventory | Family Environment Scale | (A): Beck Anxiety Inventory
(B): Dyadic Adjustment Scale
(C): Minnesota Multiphasic Personality Inventory
(D): Family Environment Scale | Dyadic Adjustment Scale | B | The Dyadic Adjustment Scale, a 32-question scale that assesses each individual’s perception of the relationship and is used to assess for marital satisfaction, would be helpful for assessing each individual’s satisfaction in the marriage and may prompt processing of what brought the couple to the point at which the wife had an affair. The wife has generalized anxiety disorder, which can be tracked using the Beck Anxiety Inventory; however, this would not be the focus of couples counseling. The Minnesota Multiphasic Personality Inventory may give insight into personality traits of both individuals; however, it would not be indicated at this point in counseling. The Family Environment Scale focuses more on the family system as a whole and not just the parental unit. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,323 | Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice | The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations. | First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, "I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room." He continues with a tearful eye, "I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me." You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels "really low" and his mind tells him that he would be better off dead. Other times, he feels "pretty good" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a "series of negative events" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually "give up" on him. When asked about his parents, he softly laughs and says, "They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy." You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to "give counseling a try" and see you for another session. You schedule an appointment to see him the following week. Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, "It sure has been a journey these past few days." He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as "mind-blowing", and states that this adventure has helped him design his new goal, which will be "life-changing." He goes on to say that his boss "didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home." He laughs when he relates that he had turned his phone off, so he didn't have to be "brought down." He recognizes that he had made commitments to work over the weekend, but he states, "If you met this girl, you'd know why I did it." Then laughs. You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way. 10th session As you have been working with the client over the past two and a half months, he has made significant progress with treatment goals, including mood stabilization and behavioral control. In the last session, as you reviewed the progress that the client had made over the course of treatment, you both agreed that the client was ready for termination as he felt he had gotten what he needed from therapy. The client was especially pleased when considering his progress in mood regulation and mindfulness, as well as addressing his thrill-seeking behaviors during his manic phases. For this final session, the client arrived ten minutes late. He appears out of breath as he runs into the room. The client states that he got a call from the hospital where his sister was just admitted. As he describes the phone call, he pauses and looks out the window with tears in his eyes. You ask him how he feels. The client responds quietly, "I don't know, my sister has been in a serious accident, and I don't know how I'll continue without her support," prompting you to recognize that unresolved issues may require additional therapy. You state, "It sounds like your sister's accident has brought up a lot of emotions for you. You are feeling overwhelmed and unsure about how to cope without her support. It must be difficult to process all of this at once." The client nods his head. You continue by telling him that it is natural to feel overwhelmed and uncertain in a situation like this. You engage him in a discussion about coping strategies or support systems that have helped him in the past when facing difficult challenges. You also ask him if it would be helpful to have additional therapy sessions during this time to which he replies, "Yes, I don't want to undo all the progress I've made." | The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, "Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off." The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially. | What recommendation would be most helpful for this client, given the additional revelations? | Adult Care Management support | Yoga and guided imagery exercises | Engage in Bipolar Group Therapy | A local Bipolar support group | (A): Adult Care Management support
(B): Yoga and guided imagery exercises
(C): Engage in Bipolar Group Therapy
(D): A local Bipolar support group | A local Bipolar support group | D | Support groups such as Depression and Bipolar Support Alliance groups can be a good resource. Therefore, the correct answer is (B) | treatment planning |
1,324 | Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor. | First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the "latest incident at school," wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow. His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact. Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is "concerned about the stigma associated with Autism" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the "right help." Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs. You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain. In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was "short." This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action. Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party. Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds. Fifth session As today's session starts, the client's mother says she is at her "wit's end" because her son is getting worse. As a result, the school may not let the client come back next year. In addition, there has been a major incident at home. The mother, stepfather, and younger sister went for a drive without the client. When they returned, the client was upset and claimed that no one in the family loved him; he wanted to live with his grandmother. The mother responded that his behavior was unacceptable and that he would not live with his grandmother. Jackson went into his bedroom and began throwing objects around the room in anger after his family left without him. He broke a lamp and overturned his dresser. Jackson's destructive outburst caused damage to his possessions and his room. After his mother told Jackson a second time that he could not live with his grandmother, he started shouting insults at her and his stepfather. Jackson then told them they were not fit parents and only cared about themselves. In response, his mother told him he was not getting his laptop back until his behavior improved. The client grabbed a dish, threw it against the wall, and threatened to break more items in the home. He said he would continue his destructive behavior until his family realized how much they hurt him on a daily basis and then ran out the door. The stepfather found him wandering the neighborhood and drove him home. Jackson told his stepfather he wished he was dead and not part of their family. You note that the client is pulling his hair as he tells you this. You also notice that he is decompensating. You spend the remainder of the session practicing self-calming skills with him. | The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers. The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive. The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. | What is the most effective method to help the client express his feelings during therapy? | Use only open-ended questions | Play the video game with him to serve as a distraction | Employ listening and attending skills | Use mostly close-ended questions | (A): Use only open-ended questions
(B): Play the video game with him to serve as a distraction
(C): Employ listening and attending skills
(D): Use mostly close-ended questions | Employ listening and attending skills | C | The best approach is to let the client tell you how he is feeling and reflect on his feelings to show him that he is being heard. A simple "Tell me more about that feeling of being unloved" could help. Therefore, the correct answer is (A) | counseling skills and interventions |
1,325 | 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. | According to the DSM-5-TR, which of the following is considered a differential diagnosis for Major Depressive Disorder? | Premenstrual Dysphoric Disorder | Body Dysmorphic Disorder | Dissociative Amnesia | Anorexia Nervosa | (A): Premenstrual Dysphoric Disorder
(B): Body Dysmorphic Disorder
(C): Dissociative Amnesia
(D): Anorexia Nervosa | Premenstrual Dysphoric Disorder | A | Premenstrual Dysphoric Disorder is a differential for Major Depressive Disorder. It is present in the final week before the onset of menses, and that starts to improve within a few days after the beginning of menses. It becomes minimal or absent in the week postmenses. It is marked by a psychosocial stressor that leads to marked impairment. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,326 | 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. The wife’s anxiety appears to be clinically significant because it impacts the relationship | The wife’s anxiety appears to be clinically significant because it impacts the relationship. Which would be an appropriate first course of action regarding the wife’s treatment for anxiety? | Incorporate cognitive reframing and coping skills for anxiety in couples counseling sessions. | Provide individual counseling to the wife for anxiety. | Provide a referral for individual counseling for anxiety. | Provide a referral for medication management. | (A): Incorporate cognitive reframing and coping skills for anxiety in couples counseling sessions.
(B): Provide individual counseling to the wife for anxiety.
(C): Provide a referral for individual counseling for anxiety.
(D): Provide a referral for medication management. | Provide a referral for individual counseling for anxiety. | C | The first course of action would be for the wife to receive individual outpatient therapy for her anxiety because it is clinically significant. You would not provide individual therapy for her because this would create bias in your provision of couples counseling. Medication management might be beneficial for the wife, but it would be helpful for the individual therapist to make this referral because they will be working specifically on her anxiety. Your focus with the couple is their relationship and not the wife’s anxiety. Although cognitive reframing may be helpful for the couple, couples counseling should be focused on the couple’s needs and not on the wife’s individual diagnosis. Therefore, the correct answer is (D) | treatment planning |
1,327 | Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3) | Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua | You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member. | rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives | Which of the following is considered a differential diagnosis for borderline personality disorder? | Post-traumatic stress disorder (PTSD) | Alcohol use disorder | Conduct disorder | Reactive attachment disorder | (A): Post-traumatic stress disorder (PTSD)
(B): Alcohol use disorder
(C): Conduct disorder
(D): Reactive attachment disorder | Alcohol use disorder | B | Alcohol use disorder and other substance use disorders are important to consider for these clients with suspected borderline personality disorder. Although the symptoms that these individuals experience may be due to the substance use that is common in individuals with borderline personality disorder, alcohol use disorder must first be ruled out as the primary cause of the individual’s symptoms. Reactive attachment disorder has similar symptoms but is typically a childhood disorder and would not be considered for an adult. Although conduct disorder does have behavioral or relational issues, it would not be considered a differential diagnosis. PTSD commonly co-occurs with BPD, but it is not considered a differential diagnosis. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,328 | Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual | The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
| Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major. He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested. | null | While the counselor gains information, the counselor should not? | Deny any cultural biases the counselor is feeling | Gain an understanding of his spheres of influence | Find out about his interests and hobbies | Ask Darrel what he does for work | (A): Deny any cultural biases the counselor is feeling
(B): Gain an understanding of his spheres of influence
(C): Find out about his interests and hobbies
(D): Ask Darrel what he does for work | Deny any cultural biases the counselor is feeling | A | Counselors are obligated to be aware and sensitive to other cultures. It is also necessary to acknowledge cultural biases and not try to deny them. Acknowledging one's own biases is the only way to effectively work on overcoming them. A comprehensive assessment not only includes the counselor's self-awareness, but also includes information on many aspects of the person's life including strengths, interests, and hobbies. Finding out what Darrel does for work can give pertinent information on why he looks so tired. Finding out about his spheres of influence can give the counselor an even larger picture of Darrel's support system and other factors that may be influencing his feelings and behaviors. Therefore, the correct answer is (D) | professional practice and ethics |
1,329 | Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography | You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues. | use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends. The client requests behavioral changes that can help reduce the frequency of masturbation | The client requests behavioral changes that can help reduce the frequency of masturbation. All of the following behavioral interventions can support a reduction in the desire for masturbation, EXCEPT: | Blocking pornographic websites | Spending time with family or friends | Focusing on improving self-esteem | Exercise | (A): Blocking pornographic websites
(B): Spending time with family or friends
(C): Focusing on improving self-esteem
(D): Exercise | Focusing on improving self-esteem | C | Focusing on improving self-esteem might help reduce the frequency of masturbation; however, it is not a behavioral intervention. Exercise releases chemicals in the body that improve mood and can help reduce the desire to masturbate. Spending time with family or friends can be helpful in extinguishing masturbation urges, especially if a root cause of these urges is loneliness. Blocking pornographic websites limits or delays the client’s access to contributory resources for his masturbation, which can provide the client with time to use coping skills to manage the urge to masturbate. Therefore, the correct answer is (D) | treatment planning |
1,330 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital. | The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals. You co-lead the client’s group and use social skills training to help the client with his long-term treatment goals | You co-lead the client’s group and use social skills training to help the client with his long-term treatment goals. Which principle of operant conditioning underlies the use of cueing, coaching, and prompting? | Social modeling | Environmental restructuring | Behavioral practice | Discriminative stimuli | (A): Social modeling
(B): Environmental restructuring
(C): Behavioral practice
(D): Discriminative stimuli | Discriminative stimuli | D | The operant conditioning principle underlying cueing, coaching, and prompting is discriminative stimuli. Discriminative stimuli is based on the premise that certain behaviors were reliably reinforced in the past. These reinforced behaviors now serve as the antecedent stimulus that increases the probability of a response because of a history of reinforcing selected behavior (ie, differential reinforcement). Modeling is a social learning concept, making it incorrect. Environmental restructuring influences behavior by permanently changing one’s physical surroundings. Behavioral practice is a component of social skills training but is different than discriminative stimuli in that it involves repeating the learned skill until it reaches the point where it can be successfully generalized to real-life encounters. Therefore, the correct answer is (B) | counseling skills and interventions |
1,331 | Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor. | First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the "latest incident at school," wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow. His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact. Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is "concerned about the stigma associated with Autism" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the "right help." Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs. You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain. In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was "short." This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action. Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party. Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds. | The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers. The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive. The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. | Which short-term goal would you prioritize as you develop a treatment plan for the client? | Decrease angry outbursts and behaviors | Decrease his defiance toward his mother | Decrease bullying | Decrease anxiety | (A): Decrease angry outbursts and behaviors
(B): Decrease his defiance toward his mother
(C): Decrease bullying
(D): Decrease anxiety | Decrease angry outbursts and behaviors | A | You are considering the diagnosis and his school behaviors which have led to expulsions. Decreasing angry outbursts and subsequent behaviors is the most critical goal on which to work. Therefore, the correct answer is (D) | treatment planning |
1,332 | 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. | According to the American Psychiatric Association's guidelines for clients with eating disorders, what level of care would be appropriate for the client at this time? | Intensive outpatient | Inpatient treatment | Residential treatment | Partial hospitalization | (A): Intensive outpatient
(B): Inpatient treatment
(C): Residential treatment
(D): Partial hospitalization | Intensive outpatient | A | Based on the client's symptoms and presentation, it is appropriate to recommend an intensive outpatient level of care. The client is displaying signs of anxiety, poor body image, restricted eating, compulsive exercise, and avoidance of social situations. These are all warning signs that require an increased level of care. Intensive outpatient treatment provides the support, structure, and guidance necessary to help the client safely explore her issues and develop healthy coping strategies. The intensity of the program allows the client to continue attending school or working while receiving treatment. Therefore, the correct answer is (C) | counseling skills and interventions |
1,333 | Initial Intake: Age: 4 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual | Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session. | Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.
History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case. | null | Destiny is displaying symptoms of Reactive Attachment Disorder. Differentiators between Autism spectrum disorder and Reactive attachment disorder may include all of the following except? | Restrictive interests and repetitive behaviors are associated with Autism spectrum disorder | Both can exhibit a range in intellectual functioning | Reactive attachment disorder does not have cognitive and language delays | Those with reactive attachment disorder have a history of severe social neglect | (A): Restrictive interests and repetitive behaviors are associated with Autism spectrum disorder
(B): Both can exhibit a range in intellectual functioning
(C): Reactive attachment disorder does not have cognitive and language delays
(D): Those with reactive attachment disorder have a history of severe social neglect | Reactive attachment disorder does not have cognitive and language delays | C | Individuals diagnosed with reactive attachment disorder and autism spectrum disorder may show cognitive and language delays, as well as a range intellectual functioning. However, individuals diagnosed with autism spectrum do not have to have a history of severe social neglect. Additionally, restrictive interests and repetitive behaviors can be seen with autism spectrum disorder but not reactive attachment disorder. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,334 | Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency | The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying. | First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, "He was beaten to death because he was transgender." The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, "He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one." She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has "gotten out of hand." After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death. When asked what she is hoping to gain from therapy, she responds, "I just want to stop feeling so awful all the time." You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability. Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend. She says, "Why did he have to die? I feel like it's my fault." Next, you ask her, "What do you think caused your friend's death?" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings. Eighth session You have been seeing the client for a few months now, and she has consistently come to therapy and has made some progress, but some areas still need work. Regarding the death of her friend, she remains in the denial stage of his passing. She had been prescribed medication to help with her insomnia and depression, which seemed to be helping somewhat. In addition, she is limiting her alcohol intake, but she has not stopped drinking altogether. She had also been working on identifying her triggers for anxious distress, and you discussed several of them during previous sessions. Today, you focus on the stress the client reports in relationship to her job. You ask, "What has been going on at work that has been making you feel stressed out?" She starts to talk about her boss and seems to be caught up in the details, getting lost in her story. You notice her becoming agitated. You ask her to explain what she is feeling and she says, "overwhelmed, frustrated, and like I can't keep up." She tells you that just talking about it makes her feel physically uncomfortable. You offer the client some grounding techniques to help her stay in the present moment. You suggest she take a few deep breaths and focus on her breathing. You then ask her to focus on her physical sensations, including any tension or tightness in her body and gently encourage her to release that tension. You suggest she identify something in the room that can help her stay grounded and focus on it if her mind starts to wander. When she appears to be calm again, you ask her to describe the situation at work that is causing her the most distress in simple terms, without getting caught up in details. The client goes on to explain that her supervisor is often critical of her and she feels as though he does not appreciate the hard work she puts in. You listen to her and empathize, then encourage her to think about specific ways she can address the situation at work. You suggest that she start by making a list of her skills and competencies, so that she can remind herself of her worth when feeling attacked. Throughout the session, you mirror the client's body language by following her lead. When she leans forward, you lean forward. When she furrows her brows or crosses her arms, you do the same. You also make eye contact with the client, giving her your undivided attention. | The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, "It was like my dad leaving us just made everything worse." The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as "okay, but not something I'm passionate about." She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. | What are you attempting to do when you mirror the client's body language during the session? | Engage the client in reframing | Utilize attending skills | Employ the exaggeration exercise | Demonstrate unconditional positive regard | (A): Engage the client in reframing
(B): Utilize attending skills
(C): Employ the exaggeration exercise
(D): Demonstrate unconditional positive regard | Utilize attending skills | B | Attending skills involves the therapist listening to the client and giving them your undivided attention. Therefore, the correct answer is (D) | counseling skills and interventions |
1,335 | 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 | Tony asks that the counselor not tell his wife about wearing her clothes prior to the time she walked in on him. How should the counselor respond? | Are you sure that is what you want to do? | I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable | That goes against the ground rules we set last week | Okay, only this time | (A): Are you sure that is what you want to do?
(B): I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable
(C): That goes against the ground rules we set last week
(D): Okay, only this time | I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable | B | This choice validates Tony's feelings but also talks about a way to honor was agreed upon before the individual session. Prior to the session with Tony, all parties agreed that whatever is stated in the individual session will be shared in the next session. If this is not done, this may disrupt the therapeutic relationship. If the counselor agrees to it just one time, Tony may ask again to keep something from Kathleen and an alliance may form between Tony and the counselor. This would be a violation of trust if Kathleen found out. Selection b does not directly address the issue at hand and choice c may cause Tony to be defensive. Therefore, the correct answer is (D) | counseling skills and interventions |
1,336 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express | You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex. | Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4) ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother | Which one of the following would be the most beneficial collaborator(s) for holistic treatment planning in this scenario? | The client’s PCP | A psychiatrist | The client’s friends | The client’s girlfriend | (A): The client’s PCP
(B): A psychiatrist
(C): The client’s friends
(D): The client’s girlfriend | The client’s PCP | A | The client’s PCP would be the most beneficial contact for collaboration in a holistic approach because the concern includes the influence of a medical condition. A psychiatrist is an important collaborator for mental health needs, especially when psychopharmacy is required, but this would neglect the focus on the client’s medical needs. The client’s girlfriend and the client’s friends also do not address the physical needs of the client’s medical condition and therefore would not characterize the most holistic approach. Therefore, the correct answer is (A) | treatment planning |
1,337 | Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0) | Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th | You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species. | e The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services | Which statement would best help enhance the client’s motivation to change? | “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.” | “Your girlfriend declined to have sex with you, but you’ve decided to keep trying.” | “You’re disappointed your girlfriend is not having sex with you, but just like building a building, intimate relationships are constructed one brick at a time.” | “You’re disappointed that your girlfriend doesn’t want to have sex with you. I believe I can help, but the ball is in your court.” | (A): “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”
(B): “Your girlfriend declined to have sex with you, but you’ve decided to keep trying.”
(C): “You’re disappointed your girlfriend is not having sex with you, but just like building a building, intimate relationships are constructed one brick at a time.”
(D): “You’re disappointed that your girlfriend doesn’t want to have sex with you. I believe I can help, but the ball is in your court.” | “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.” | A | Of all answer options, increasing the client’s motivation to change is best attained by stating, “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you” The statement is an example of an empathetic reflection, a micro skill associated with strengthening the counselor-client relationship. The statement also sets the stage for establishing a discrepancy between the client’s values or expectations and current behaviors. It is a natural lead to discussing what an intimate relationship looks like, the reality of exploring it, and the appropriateness of establishing it. The therapeutic alliance is strongly associated with increased motivation to change. Answer A attempts to engage the client by using his major in architectural design to create an analogy between the building blocks of an intimate relationship and building an actual building. This statement is likely to be misunderstood because individuals on the autism spectrum think concretely and not metaphorically. Telling the client that the ball is in his court is also a statement that, if taken literally, creates a misunderstanding. The statement, “Your girlfriend declined to have sex with you, but you’ve decided to keep trying,” is a paraphrase. A paraphrase reflects the factual aspects of the client’s statements. Paraphrases let clients know that they are being heard, but they are not as powerful as empathetic reflections. Therefore, the correct answer is (B) | counseling skills and interventions |
1,338 | Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0) | Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa | You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive. | The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening | Based on the topics discussed during today’s session, which of the following would be the most appropriate homework assignment? | The couple will engage in sexual intercourse twice over the next week in order to increase intimacy. | The couple will engage in conflict resolution skills when experiencing significant conflict. | The wife will ensure that the husband can go fishing again so he can feel validated. | Each individual will engage in a significant, loving act toward the other during the next week. | (A): The couple will engage in sexual intercourse twice over the next week in order to increase intimacy.
(B): The couple will engage in conflict resolution skills when experiencing significant conflict.
(C): The wife will ensure that the husband can go fishing again so he can feel validated.
(D): Each individual will engage in a significant, loving act toward the other during the next week. | Each individual will engage in a significant, loving act toward the other during the next week. | D | The individuals in this couple are experiencing a lack of feeling validation and interest from their partner. Engaging in loving acts would most likely address these deficiencies most effectively. Although engaging in sexual intercourse may lead to validation, this was not the main concern expressed during this session. The wife focusing on guaranteeing that the husband has time to fish displays empathy and support for the husband, but it does not improve their issues with validation and connection. The couple needs to continue working on conflict resolution; however, feelings of connectedness are the couple’s main focus in this session. Therefore, the correct answer is (A) | counseling skills and interventions |
1,339 | 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.” | What is your next course of action? | Inform Gina you cannot speak with her due to conflict of interest. | Report the incident to the presiding judge over Davone's court order. | Obtain written consent from Davone to speak with his ex-wife. | Do not respond to the voicemail and speak with the PO about confidentiality. | (A): Inform Gina you cannot speak with her due to conflict of interest.
(B): Report the incident to the presiding judge over Davone's court order.
(C): Obtain written consent from Davone to speak with his ex-wife.
(D): Do not respond to the voicemail and speak with the PO about confidentiality. | Do not respond to the voicemail and speak with the PO about confidentiality. | D | It is inappropriate in this situation for you to speak with Davone's ex-wife or to any judge involved in his court case due to HIPAA and for other legal reasons. Discussing the voicemail with Davone and the possibility of speaking with his ex-wife can be something accomplished at your discretion as the counselor, however based on his presentation in session and her demands over the phone it is not the best option clinically for your client. Simply leaving the voicemail recorded but unaddressed and reviewing confidentiality with his probation officer (or at least discussing with them how she got your number if not from them) is the best choice. Therefore, the correct answer is (A) | professional practice and ethics |
1,340 | 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. | Following today's session, the client's husband called you and apologized for his behavior that he feels resulted in his wife being hospitalized. He indicated that he was now willing to do whatever it takes to help his wife get better and asked if you could give him any insight into his wife's current mental health needs. How would you respond? | Without going into detail, you can share your general impressions regarding his wife. | You can suggest actions and behaviors the husband should consider. | As her husband was a co-occurring participant in her hospitalization, you can share information about his wife's health. | You must maintain the confidentiality of the client's sessions | (A): Without going into detail, you can share your general impressions regarding his wife.
(B): You can suggest actions and behaviors the husband should consider.
(C): As her husband was a co-occurring participant in her hospitalization, you can share information about his wife's health.
(D): You must maintain the confidentiality of the client's sessions | You must maintain the confidentiality of the client's sessions | D | It is important for the client to be able to trust the therapist and for the therapist to maintain the confidentiality of the client’s session. It would not be appropriate for the therapist to discuss the details of the client’s session with her husband. Respect for the client’s privacy is essential to maintain a safe and therapeutic environment. Furthermore, the therapist must also ensure that their actions do not violate ethical guidelines or confidentiality laws. This can be difficult to manage when dealing with someone with a close relationship with the client, as it would be necessary to explain why certain information should not be revealed. The therapist must clearly explain the limits of what can and cannot be shared with a third party if it is deemed necessary for the client’s well-being. Therefore, the correct answer is (D) | professional practice and ethics |
1,341 | Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02) | Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem | You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up. | You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past | The client’s thoughts of worthlessness if she is overweight and that she will die as a result represent which of the following cognitive distortions? | Personalization | Emotional reasoning | Overgeneralization | Always being right | (A): Personalization
(B): Emotional reasoning
(C): Overgeneralization
(D): Always being right | Emotional reasoning | B | This cognitive distortion is considered emotional reasoning, which is defined as “I feel; therefore, it must be true” Personalization is when the client assumes that she is responsible for what happened and would not define the present cognitive distortion. This cognitive distortion is also not an example of “always being right” because the client is not expressing that the possibility that she is wrong is unacceptable. Overgeneralization is when the client assumes a generalized rule from a singular experience. Overgeneralization may explain why she feels like she is going to die because her mother did, but it does not explain why she feels being overweight means that she has no worth. Therefore, the correct answer is (C) | counseling skills and interventions |
1,342 | Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences. | First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, "I can't live with the pain of our separation much longer, and I don't know how to cope with it." She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction. You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because "it helps numb the pain and I can forget about everything for a little while." The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, "One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother." She pauses for a moment, then says, "Well, not yet anyway. I've got some court costs coming up." You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now. | The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, "My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling." Although the client does not feel that her family understands her problems, she does communicate with her mother weekly. The client has been using alcohol as a way to cope with stress for many years. She expresses she has "been through a lot" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life. | The client presents as a hurting, confused, and scared individual, who nonetheless is a successful and respected attorney. What is the best way to establish and maintain a working and effective therapeutic relationship in this case? | Set clear boundaries with the client to promote healthy interactions | Help the client identify ways to achieve her goals | Show genuine acceptance and understanding for the client | Avoid making assumptions about her situation | (A): Set clear boundaries with the client to promote healthy interactions
(B): Help the client identify ways to achieve her goals
(C): Show genuine acceptance and understanding for the client
(D): Avoid making assumptions about her situation | Show genuine acceptance and understanding for the client | C | Congruence is an important concept in therapeutic counseling. It involves a therapist demonstrating genuine acceptance and understanding for the client by being authentic, honest, and transparent. Congruence also involves conveying empathy and unconditional positive regard towards the client, as well as refraining from judging or minimizing the client's experiences. This helps to create a safe space for clients to open up about their feelings and concerns. Therefore, the correct answer is (B) | core counseling attributes |
1,343 | Initial Intake: Age: 8 Gender: Male Sexual Orientation: N/A Ethnicity: Caucasian Relationship Status: N/A Counseling Setting: Through agency inside school and via telehealth Type of Counseling: Individual | Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home. | Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors. | Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school. | In response to Avery's parents telling you how difficult it is to get him to sleep, you reply saying "I completely understand it must be difficult! I am here to help however I can." This is an example of? | Development of conflict resolution strategies | Empathic responding using validation and therapeutic alliance | Reverse reflection and deflection | Non-judgmental stance | (A): Development of conflict resolution strategies
(B): Empathic responding using validation and therapeutic alliance
(C): Reverse reflection and deflection
(D): Non-judgmental stance | Empathic responding using validation and therapeutic alliance | B | This is an example of showing empathy by validating a client's feelings and reinforcing the therapeutic relationship by reminding them of your commitment to give your clinical resources to help alleviate their distress. Answer a) is a fabricated counseling skill. All clinical services should be provided from a non-judgmental position, offering unconditional positive regard as best practice. Developing resolution to their conflicts is at times a collaborative process along with the client, as well as it is a teaching process, that will continue throughout the course of their treatment. If the response were to include strategies, there would be instructions and SMART goals involved. This response was merely using core counseling attributes as a skill to enhance the client's trust and comfort their apparent frustrations. Therefore, the correct answer is (D) | counseling skills and interventions |
1,344 | 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 | Which one of the following assessment instruments provides ADHD rating scales for parents and teachers? | Conners Rating Scale (CRS) | ADHD Rating Scale-IV (ADHD-RS-IV) with Adult Prompts | Ages and Stages Questionnaire (ASQ) | Woodcock-Johnson IV (WJ IV) | (A): Conners Rating Scale (CRS)
(B): ADHD Rating Scale-IV (ADHD-RS-IV) with Adult Prompts
(C): Ages and Stages Questionnaire (ASQ)
(D): Woodcock-Johnson IV (WJ IV) | Conners Rating Scale (CRS) | A | The CRS has rating scales for parents and teachers. The CRS can be used with children ages 6–18, and it assesses ADHD and associated comorbid disorders. Parent and teacher scales are critical for diagnostic purposes because ADHD must occur in more than one setting (eg, at home and at school). The ADHD-RS-IV with Adult Prompts is used to assess ADHD symptoms in adults. The WJ IV is an intelligence test that evaluates a wide range of cognitive functions with three batteries: the WJ IV Tests of Cognitive Abilities, the WJ IV Tests of Oral Language, and the WJ IV Tests of Achievement. Finally, the ASQ is a socioemotional and developmental screening tool for children between birth and age 6. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,345 | 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. | 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. | Given the client's outburst, what would your next step be if using a Gestalt approach? | You would model the behavior back to the client by throwing an object that belongs to her, to help her to experience the here-and-now consequences of her actions. | You would seek to redirect the client from her inappropriate outburst, to help the client defuse intense feelings and thus normalize her behaviors. | You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process. | You would introduce humor as a way to deflect intense emotions from the client's outburst, aiding her in finding ways to self-regulate. | (A): You would model the behavior back to the client by throwing an object that belongs to her, to help her to experience the here-and-now consequences of her actions.
(B): You would seek to redirect the client from her inappropriate outburst, to help the client defuse intense feelings and thus normalize her behaviors.
(C): You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process.
(D): You would introduce humor as a way to deflect intense emotions from the client's outburst, aiding her in finding ways to self-regulate. | You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process. | C | The Gestalt therapist seeks to get the client to experience intense emotions and acknowledge them in the here and now. Therefore, the correct answer is (D) | counseling skills and interventions |
1,346 | 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. You consider yourself evangelical and uphold values consistent with church teachings | You consider yourself evangelical and uphold values consistent with church teachings. How should you handle your opposing values? | Speak to your supervisor about referring the client. | Seek guidance and consultation from the client. | Tell your supervisor about the issue and agree to follow-up if it becomes problematic. | Seek professional training in that area and continue to work with the client. | (A): Speak to your supervisor about referring the client.
(B): Seek guidance and consultation from the client.
(C): Tell your supervisor about the issue and agree to follow-up if it becomes problematic.
(D): Seek professional training in that area and continue to work with the client. | Seek professional training in that area and continue to work with the client. | D | The best way to handle your opposing values is to seek professional training in that area and continue to work with the client. Seeking professional training and supervision is designed to honor ethical counseling principles, specifically justice, nonmaleficence, and beneficence, and to preserve a safe counseling environment. According to the ACA Code of Ethics (2014), counselors avoid imposing “their own values, attitudes, beliefs, and behaviors” 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” The primary focus of treatment must always be the client’s goals and desired outcome. When opposing values are brought into the counseling process, the counselor is no longer impartial, and there is a danger of harming the client. Seeking guidance and consultation from the client is incorrect because of the power differential and the counselor’s responsibility to obtain professional guidance. Referring the client to another provider is incorrect because “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors (ACA, 2014)”. Therefore, the correct answer is (B) | professional practice and ethics |
1,347 | Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control. She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes. | You are a counselor in a private practice setting. During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex. | Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births. | Which of the following would help you develop trust with the client during this first session? | Explain the phases of counseling so she knows what to expect | Helping the client identify some simple boundaries to implement with her spouse | Setting treatment goals | Collaborating on selecting a support system for the client | (A): Explain the phases of counseling so she knows what to expect
(B): Helping the client identify some simple boundaries to implement with her spouse
(C): Setting treatment goals
(D): Collaborating on selecting a support system for the client | Setting treatment goals | C | Setting treatment goals is a collaborative process in counseling that requires the counselor to demonstrate having listened to and understood the client's concerns, values, beliefs, and the desired outcome from counseling. In promoting the welfare of the client, the counselor demonstrates respect for the client and encourages them to trust the counseling process and the therapeutic relationship. Explaining what to expect from counseling occurs at the beginning of the session when reviewing the Informed Consent. Selecting a support system and identifying boundaries are both important parts of the counseling process, but are more effective once the therapeutic relationship and trust have been established. Therefore, the correct answer is (A) | treatment planning |
1,348 | 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.” You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling | You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling. This model suggests that change is least likely to occur in which of the following stages: | Action | Maintenance | Contemplation | Preparation | (A): Action
(B): Maintenance
(C): Contemplation
(D): Preparation | Contemplation | C | Of the stages listed, contemplation is the one that is least likely to produce change. Prochaska and DiClemente’s (1992) transtheoretical model of change consists of the following linear stages: precontemplation, contemplation, preparation, action, and maintenance. Individuals in stage 1, or the precontemplation stage, lack awareness of behaviors that may require change. In stage 2, the contemplation stage, individuals are aware that changes need to be made but are ambivalent about taking action. In stage 3, the preparation/determination stage, individuals acknowledge the detrimental consequences of their behavior and get ready to make a change. The action stage, or stage 4, is also known as the willpower stage because the person acknowledges that a change needs to be made and is taking steps to change. Finally, in stage 5, the maintenance stage, individuals take the action steps required to sustain change. Termination or relapse may follow the maintenance stage if changes are not necessary or sustained. Therefore, the correct answer is (D) | counseling skills and interventions |
1,349 | Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0) | Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa | You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive. | tion. Family History: The husband and wife have been married for 13 years. They report that they met when friends introduced them and that they dated for about 2 years before getting married. The couple have two children: two daughters (ages 7 and 10). The couple reports that they have been in “parent mode” for the past few years and have not been emotionally connected to each other because their attention has been predominantly focused on their children | Which of the following is a unique ethical consideration for couples counseling versus individual counseling? | Professional competency | Autonomy | Dual relationships | Extensions of the counseling boundaries | (A): Professional competency
(B): Autonomy
(C): Dual relationships
(D): Extensions of the counseling boundaries | Autonomy | B | Autonomy is a core counseling value and is more difficult to maintain in couples counseling because there are two individuals that are both due their right to autonomy. Both individuals have varying needs, and you must balance focusing on the collective needs with focusing on the individual needs. Dual relationships, extensions of the counseling boundaries, and professional competency are factors that are less influenced by the dynamic of couples counseling. Therefore, the correct answer is (A) | professional practice and ethics |
1,350 | 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. | Which of Raul's behaviors would not necessarily meet criteria for his ADHD diagnosis? | Impulsivity | Falling asleep in class | Desire for validation | Asking you repeat a question | (A): Impulsivity
(B): Falling asleep in class
(C): Desire for validation
(D): Asking you repeat a question | Desire for validation | C | There is no evidence to support Raul's "class clown" behaviors have anything to do with ADHD. Common behaviors of children with ADHD involve inattention and impulsivity. While falling asleep in class in and of itself is not a criterion for ADHD, it is possible Raul feels overwhelmed or disengaged in class, therefore due to his inattentive type processing he may become sleepy when bored. It is also possible over-stimulation at other times of the day or night may make it difficult for him to get needed rest when it is more appropriate. If given too much information to process at once, a client with ADHD might lose focus and be incapable of remembering what was just said to them causing them to ask you to repeat it. Using single step directions and relatively short comments in conversations with clients whose ADHD is untreated can be helpful for them to process more easily what you are saying. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,351 | 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).” | 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).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown. The client is wearing a low-cut blouse and short shorts while stating that she attempted suicide due to her last boyfriend “ghosting” her | The client is wearing a low-cut blouse and short shorts while stating that she attempted suicide due to her last boyfriend “ghosting” her. Carl Jung would most likely view this as an expression of which one of the following? | Persona | Anima | Electra complex | Parapraxis | (A): Persona
(B): Anima
(C): Electra complex
(D): Parapraxis | Persona | A | Carl Jung would most likely view the combination of the client’s attire and her recent suicide attempt stemming from a bad breakup as her persona. Jung described the persona as “the social face the individual presented to the world—a kind of mask, designed on the one hand to make a definite impression upon others, and on the other to conceal the true nature of the individual” (Jung, 1953). The client’s sexualized manner of dress may serve as a means of concealing the true nature of her pain and underlying fear of abandonment. Jung is also known for the Electra complex, which he used to describe a female’s unconscious desire for her father’s love and attention. The anima, another concept originating from Jung, refers to the unconscious feminine side of a man. Finally, parapraxis is a Freudian concept used to describe an unconscious slip of the tongue or Freudian slip. Therefore, the correct answer is (A) | counseling skills and interventions |
1,352 | Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual | Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor. | Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs. | null | To obtain more information the counselor should first? | Interview Harold's coworkers | Determine a diagnosis | Conduct a drug test | Conduct a biopsychosocial | (A): Interview Harold's coworkers
(B): Determine a diagnosis
(C): Conduct a drug test
(D): Conduct a biopsychosocial | Conduct a biopsychosocial | D | A comprehensive biopsychosocial is usually the first step of the intake and assessment process to gain information on a client's past in the main life domains. It is not the counselor's responsibility to interview Harold's coworkers because of the complaints, and meeting with them may cause suspicion from Harold. It is too early to determine a diagnosis. Although Harold's coworker indicated possible drug use, a drug test is not yet indicated. A drug screening is usually part of the initial biopsychosocial. A drug test may be necessary if the drug screening indicates so. Therefore, the correct answer is (A) | counseling skills and interventions |
1,353 | 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 | Which one of the following therapeutic foci is most effective for a 4-year-old with attachment difficulties? | Rational emotive behavior therapy | Psychodynamic therapy | Bibliotherapy | Play therapy | (A): Rational emotive behavior therapy
(B): Psychodynamic therapy
(C): Bibliotherapy
(D): Play therapy | Play therapy | D | Play therapy would be the most effective approach for this client because she is 4 years old and would benefit from playing out life circumstances instead of talking through them. Rational emotive behavior therapy would likely be above the cognitive level of the client because it requires the client to process rational and irrational thought processes. Bibliotherapy involves the use of books for therapy; the client is likely too young to benefit from this focus. Psychodynamic therapy focuses on identifying and processing one’s emotions; the client is not at a cognitive level at which she can participate in this type of therapy. Therefore, the correct answer is (B) | counseling skills and interventions |
1,354 | 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. | 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. | Which of the Four Horsemen of the Gottman Methods of Couples Therapy is the husband exhibiting in his interactions with his wife? | Stonewalling | Defensiveness | Contempt | Criticism | (A): Stonewalling
(B): Defensiveness
(C): Contempt
(D): Criticism | Contempt | C | The second horseman is Contempt. This horseman goes beyond criticism to being downright mean and disrespectful. According to Gottman, contempt was the greatest predictor of divorce. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,355 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Engaged Counseling Setting: Agency - Telehealth Type of Counseling: Individual | Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago. | Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9)
You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability. | Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him. | What would be the most effective person-centered objective within the client's treatment plan goal of addressing trauma? | Client will engage in narrative and exposure therapy interventions weekly for six months. | Client will learn new coping skills to help ameliorate anxious distress. | Client will process her trauma by discussing and receiving feedback on thoughts, emotions, and behaviors on a weekly basis with therapist. | Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months. | (A): Client will engage in narrative and exposure therapy interventions weekly for six months.
(B): Client will learn new coping skills to help ameliorate anxious distress.
(C): Client will process her trauma by discussing and receiving feedback on thoughts, emotions, and behaviors on a weekly basis with therapist.
(D): Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months. | Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months. | D | Objectives must call the client to action while also being SMART (specific, measurable, achievable, realistic, timely). Answer a) is not specific, measurable, or timely. Answer b) is not person-centered; it is too direct in its interventions which might be challenging for a person with high anxiety who is processing her unresolved trauma while transitioning psychiatric medications. The client has already accomplished answer d) by electing to re-engage in therapy when referred. Therefore, the correct answer is (C) | treatment planning |
1,356 | 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. | After several more sessions with Raul over three months, you conclude he is intrinsically unmotivated for counseling and has no interest in applying taught skills or achieving stated objectives. He is continually resistant and demonstrates no insight into his behaviors. How should you proceed? | Move up to twice weekly sessions. | Proceed with discharge. | Discuss alternate options with Raul and mom. | Discuss alternate options with mom and school. | (A): Move up to twice weekly sessions.
(B): Proceed with discharge.
(C): Discuss alternate options with Raul and mom.
(D): Discuss alternate options with mom and school. | Discuss alternate options with Raul and mom. | C | When coming to a place with a client where they are not showing evidence of improvement, it is best to have a conversation centered around what is best for them moving forward. In this case, speaking with Raul and his mother are the only individuals necessary for this conversation. Discharging right away is not the best choice therapeutically for Raul unless this becomes both of their decision after a thorough discussion of the consequences of termination. Increasing frequency of sessions will not necessarily improve client motivation. Working to resolve meeting their needs in a variety of ways, or discussing referrals and community resources that might be helpful for them, is the best choice. Therefore, the correct answer is (C) | treatment planning |
1,357 | Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual | Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings. | Diagnosis: Acute Stress Reaction (F43.0), Provisional
You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established. | Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father. | Assuming you can obtain consent from Maria's grandmother to continue counseling, you discuss with Maria the goals of counseling sessions while her family is in crisis. What should you tell her? | "I am going to teach you how to cope with this tragedy step by step." | "We will be discussing your traumatic recall and emotional processing to avoid dissociation." | "We will work together on helping you and your siblings feel safe and supported." | "We can talk about anything you want, and I won't tell anyone because it's private." | (A): "I am going to teach you how to cope with this tragedy step by step."
(B): "We will be discussing your traumatic recall and emotional processing to avoid dissociation."
(C): "We will work together on helping you and your siblings feel safe and supported."
(D): "We can talk about anything you want, and I won't tell anyone because it's private." | "We will work together on helping you and your siblings feel safe and supported." | C | The goals of crisis therapy are to promote a sense of safety after a trauma, help keep a client calm, promote a sense of self-efficacy, encourage community or victim connectedness, and instill a sense of hope. In the first few hours or days following a significant trauma, a client may not be ready to address their grief and loss, as they are still in shock and likely unable to process the event as well as they could weeks later through cognitive therapy. A teenager is unlikely to be motivated for counseling if they feel they will be forced to discuss a pre-written agenda, and in Maria's case it is clear she is unwilling to share her own thoughts or feelings about what happened. Using clinical language is also challenging for a teenager to connect when using simpler language would be more helpful. Telling them they can talk about whatever they want is mostly true, however you want to inform her that the purpose of the sessions is to help her through this trauma - and neglecting to share that may also come off as insensitive. Furthermore, telling a minor you will not share anything they tell you is misleading as you are required by law to break confidentiality if she reports being abused, plans to hurt herself, or is going to harm someone else. Therefore, the correct answer is (D) | treatment planning |
1,358 | Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4) | Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th | You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school. | Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling Marital Discord Diagnoses: You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago. The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce | Which one of the following methods treats childhood trauma by using bilateral stimulation to activate portions of the brain and release blocked emotional experiences? | Acceptance and commitment therapy | Interpersonal psychotherapy | Neuro-linguistic programming | Eye movement desensitization and reprocessing | (A): Acceptance and commitment therapy
(B): Interpersonal psychotherapy
(C): Neuro-linguistic programming
(D): Eye movement desensitization and reprocessing | Eye movement desensitization and reprocessing | D | Eye movement desensitization and reprocessing treats childhood trauma by using bilateral stimulation to activate portions of the brain and release blocked emotional experiences. Eye movement desensitization and reprocessing is based on the adaptive information processing model and requires specialized training for use; it involves a sequence of steps used to remove distressing emotional blocks so healing can begin. Neuro-linguistic programming providers claim that there is a connection between neurological processes, language, and patterns of behavior that can be learned through experience or programming. Critics of the method suggest that the theory is supported by anecdotal evidence only (ie, it is not an evidence-based practice). Acceptance and commitment therapy uses various techniques to help individuals accept (instead of fight) their present-moment thoughts and feelings so behavioral changes can occur. Finally, interpersonal psychotherapy is a time-limited intervention used to improve one’s social functioning to decrease emotional distress. It addresses the components of a person’s social isolation, grief, life transitions, and/or interpersonal disputes. Therefore, the correct answer is (C) | counseling skills and interventions |
1,359 | Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice | The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations. | First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, "I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room." He continues with a tearful eye, "I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me." You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels "really low" and his mind tells him that he would be better off dead. Other times, he feels "pretty good" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a "series of negative events" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually "give up" on him. When asked about his parents, he softly laughs and says, "They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy." You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to "give counseling a try" and see you for another session. You schedule an appointment to see him the following week. Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, "It sure has been a journey these past few days." He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as "mind-blowing", and states that this adventure has helped him design his new goal, which will be "life-changing." He goes on to say that his boss "didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home." He laughs when he relates that he had turned his phone off, so he didn't have to be "brought down." He recognizes that he had made commitments to work over the weekend, but he states, "If you met this girl, you'd know why I did it." Then laughs. You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way. | The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, "Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off." The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially. | The client has presented with a matrix of issues related to his manic and depressive states related to Bipolar I, including substance use. Of the following, which would be the least relevant when targeting the cyclical mood impairment associated with Bipolar I Disorder? | 12 Step Program | Mindfulness-Based Cognitive Therapy | Interpersonal and Social Rhythm Therapy | Dialectical Behavioral Therapy | (A): 12 Step Program
(B): Mindfulness-Based Cognitive Therapy
(C): Interpersonal and Social Rhythm Therapy
(D): Dialectical Behavioral Therapy | 12 Step Program | A | The 12-step program would address the client's substance use problem but not the mood component of Bipolar I Disorder. Therefore, the correct answer is (A) | treatment planning |
1,360 | Initial Intake: Age: 8 Gender: Male Sexual Orientation: N/A Ethnicity: Caucasian Relationship Status: N/A Counseling Setting: Through agency inside school and via telehealth Type of Counseling: Individual | Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home. | Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors. | Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school. | Regarding Avery's comments about desired gender, which of the following courses of action is the most clinically appropriate? | Do nothing unless Avery or his parents bring it up again as part of a problem | Add diagnosis of gender dysphoria and include gender confusion as part of goals | Do nothing because gender dysphoria for children his age is unsubstantiated | Refer parents to a support group for children coping with transgender issues | (A): Do nothing unless Avery or his parents bring it up again as part of a problem
(B): Add diagnosis of gender dysphoria and include gender confusion as part of goals
(C): Do nothing because gender dysphoria for children his age is unsubstantiated
(D): Refer parents to a support group for children coping with transgender issues | Do nothing unless Avery or his parents bring it up again as part of a problem | A | Avery was referred for counseling to address symptoms resulting from his primary diagnosis of ADHD and both of his parents are requesting help with dysregulation related to this issue only. Neither parent has expressed concern or problematic behavior resulting from gender identity confusion, merely it was mentioned as a remark that was made. While gender dysphoria can very well be a legitimate concern for a child his age, begin the treatment planning process focusing on presenting problems related to the diagnosis. Should Avery or his parents bring up gender confusion later in counseling, the issue can certainly be addressed and explored at that time. While the counselor may have a personal theory of its connection to Avery's behavioral problems, it is best practice to first rule out known existing conditions. Referrals to support groups or other referrals, should only be made when the counselor deems it appropriate outside of clinical counseling, once the problem and need have been thoroughly assessed. Therefore, the correct answer is (C) | professional practice and ethics |
1,361 | 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.” | In working with this client to facilitate insight into her personality, emotions, and behaviors, which of the following would likely be the most helpful intervention? | Values checklist | Feeling wheel | Empty chair exercises | Family genogram | (A): Values checklist
(B): Feeling wheel
(C): Empty chair exercises
(D): Family genogram | Family genogram | D | The main cause of BPD is childhood trauma and unhealthy family relationships. A family genogram, whether using CBT or DBT for treatment can help facilitate the client's understanding of historical patterns that have shaped her personality. This insight can be used to help the client identify negative core beliefs and skills that can be modified for improving distress tolerance and interpersonal relationships. Empty chair exercises are best used for clients who already possess insight and the ability to manage distress. Values checklists and feeling wheels are effective tools for helping clients identify the emotions they are feeling and the values that are most important to them. These are helpful in counseling but would not be as effective in facilitating insight as seeing familial patterns of interpersonal relationships. Therefore, the correct answer is (D) | counseling skills and interventions |
1,362 | 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. | 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. | Which is not a question you would ask during a biopsychosocial assessment? | Do you currently use any substances? | What is your annual household income? | What brings you here today? | Are you currently taking any medication? | (A): Do you currently use any substances?
(B): What is your annual household income?
(C): What brings you here today?
(D): Are you currently taking any medication? | What is your annual household income? | B | This is not a question you would ask during a biopsychosocial assessment because it does not relate to the evaluation of an individual's physical, psychological or social health. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,363 | 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. You are supervising a counseling resident, and their established client has canceled several sessions in a row | You are supervising a counseling resident, and their established client has canceled several sessions in a row. Which of the following would you encourage the counselor to do? | Contact the client to encourage them to trust the therapeutic process and continue to have sessions. | Support the client by providing an option to have a referral if they think that counseling is not working. | Follow up with the client to ascertain the reason for their cancellations. | Cancel ongoing sessions until the client can commit to regular sessions. | (A): Contact the client to encourage them to trust the therapeutic process and continue to have sessions.
(B): Support the client by providing an option to have a referral if they think that counseling is not working.
(C): Follow up with the client to ascertain the reason for their cancellations.
(D): Cancel ongoing sessions until the client can commit to regular sessions. | Follow up with the client to ascertain the reason for their cancellations. | C | Determining the reason for the cancellations is most important because this can open up a dialogue for getting back on track in the counseling relationship. It may be helpful to cancel future sessions if the client will receive cancellation fees, but this does not get to the bottom of what is happening with the client. It can also be helpful to encourage the client to trust the process, but this does not open up dialogue about what they are experiencing. If the client would like a referral, you should support them. However, it is more helpful to process what is causing the cancellations because it may be related to why the client is in treatment, and if unresolved, they may continue to have this issue with the next therapist. Therefore, the correct answer is (A) | professional practice and ethics |
1,364 | Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency | The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying. | First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, "He was beaten to death because he was transgender." The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, "He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one." She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has "gotten out of hand." After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death. When asked what she is hoping to gain from therapy, she responds, "I just want to stop feeling so awful all the time." You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability. Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend. She says, "Why did he have to die? I feel like it's my fault." Next, you ask her, "What do you think caused your friend's death?" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings. | The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, "It was like my dad leaving us just made everything worse." The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as "okay, but not something I'm passionate about." She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. | How would you best support the client's autonomy in this session? | Share your own personal experiences to try to relate to the client's situation. | Allow the client to lead the conversation and explore the topics that are most important to her. | Use reflective listening to steer the conversation towards specific treatment goals. | Use silence as a way to encourage the client to continue talking. | (A): Share your own personal experiences to try to relate to the client's situation.
(B): Allow the client to lead the conversation and explore the topics that are most important to her.
(C): Use reflective listening to steer the conversation towards specific treatment goals.
(D): Use silence as a way to encourage the client to continue talking. | Allow the client to lead the conversation and explore the topics that are most important to her. | B | This option acknowledges the importance of the client's autonomy and respects her right to make decisions about what she wants to discuss in therapy. By allowing the client to lead the conversation, the therapist can create a safe and supportive environment that encourages the client to feel comfortable expressing her thoughts and emotions. Therefore, the correct answer is (C) | counseling skills and interventions |
1,365 | 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. You and the client’s mother develop an incentive chart for the client. The mother uses a token system to reward skills learned in family therapy, and she uses planned ignoring when the client displays maladaptive behaviors | You and the client’s mother develop an incentive chart for the client. The mother uses a token system to reward skills learned in family therapy, and she uses planned ignoring when the client displays maladaptive behaviors. This is an example of which one of the following? | Exposure and response prevention (ERP) | Contingency management (CM) | Motivational interviewing (MI) | Habit reversal training (HRT) | (A): Exposure and response prevention (ERP)
(B): Contingency management (CM)
(C): Motivational interviewing (MI)
(D): Habit reversal training (HRT) | Contingency management (CM) | B | CM is based on the principle of operant conditioning and involves shaping desired behaviors. CM uses “if, then” contingencies to provide or withhold rewards in response to predetermined behaviors (eg, “if” the client stops playing video games after being asked the first time, “then” he can stay up 15 minutes past his bedtime). A token economy is a form of CM that uses positive reinforcement and extinction. Tokens serve as behavioral reinforcements and are administered when the targeted or desired behavior occurs. When the client displays maladaptive behavior, the mother ignores the behavior. Planned ignoring removes the desired response (eg, attention) through extinction. MI is a collaborative approach used to help clients resolve ambivalence and increase motivation. ERP is used with children experiencing anxiety or panic disorder; it involves incrementally exposing the child to anxiety-related triggers in a safe setting to reduce or eliminate anxiety-related responses (eg, rituals). HRT is an intervention used with children who have tics or Tourette’s syndrome. HRT techniques include identifying sensations occurring directly before the tic to respond to that urge in a new way. Therefore, the correct answer is (B) | treatment planning |
1,366 | 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. | How should you format a goal for suicidal ideation? | describe levels of SI as more or less severe | conduct updated assessments monthly | ensure the goal aims to eliminate SI | project seeing reduction in six months | (A): describe levels of SI as more or less severe
(B): conduct updated assessments monthly
(C): ensure the goal aims to eliminate SI
(D): project seeing reduction in six months | ensure the goal aims to eliminate SI | C | Your goal as the counselor should be to work towards elimination of SI and a return to a previous state of functioning before the SI began. Reduction or elimination of SI does not have to take six months; effective strategies implemented can yield positive results within days or weeks. However, if a client is not improving or is worsening, psychiatric interventions may be necessary. A client may also have long-term ideations without ever increasing in severity and still function well in daily life; but it is ethical and best practice to continually aim for elimination of this "norm" for their ultimate safety. Risk elevates with severity of ideations which progress to methods and plans, but a treatment plan goal is not considered strong if it aims to "reduce severe SI to mild SI". Check-ins regarding suicidality, whether informal or C-SSRS formatted, are appropriate at every visit until there has been a steady level of low-risk thoughts or behaviors. Again, therapists must aim to make their clients feel completely safe without any form of SI. Therefore, the correct answer is (A) | treatment planning |
1,367 | 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. Fifth session This is your fifth weekly session with the client, and she states that she likes the "structure" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, "I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal." You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, "I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships." You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family. During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she "had other stuff going on." Seventh session During today's session, the client tells you that she read a few of the chapters in the book you recommended on human sexuality, and she is starting to feel more comfortable with herself. At your suggestion, she started keeping a journal to organize her thoughts and feelings about her sexuality. She says that she has "pretty much decided to end my engagement and take some time to explore who I am and what it means to be in a relationship with another woman." She relates that she still feels homesick at times, but her roommate has been supportive and understanding. She smiles and says, "My roommate surprised me the other day by cooking a traditional dish that I told her about that my mom used to cook for us growing up. It was so comforting to have a reminder of home like that." You continue to explore the client's thoughts on telling her parents about her newfound identity, and she says that although the idea of coming out to them and breaking off her engagement is frightening, she knows it is "the right thing to do." You provide guidance on how to approach this sensitive subject in a way that may be best received by her family. You also provide additional resources that may help her learn more about navigating conversations around sexuality and sexual orientation with family and friends. The client notes that if all goes well, she'd like to take her roommate back home with her for a visit during a school break so they can spend time together away from school. | null | You say to the client, "It sounds like you have made a difficult decision to end your engagement, take some time to explore yourself, and be honest with your parents about your newfound identity. You are also feeling more comfortable learning about yourself as well as exploring what it means to be in a relationship with another woman." What skill are you using with this statement? | Summarization | Reflection of feeling | Paraphrasing | Confrontation | (A): Summarization
(B): Reflection of feeling
(C): Paraphrasing
(D): Confrontation | Summarization | A | You are taking all that the client said and repeating it back to her. Summarizing is a skill that can be used at the beginning, middle, or end of a session. Sometimes it covers certain issues discussed over many sessions. Therapists also use this skill to clarify long, complex stories that clients share. Therefore, the correct answer is (A) | counseling skills and interventions |
1,368 | 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 | Which of the following diagnoses can be ruled out based on the symptoms Theodore is exhibiting? | Normal grief reaction | Hoarding | Adjustment disorder | Persistent Depressive Disorder (Dysthymia) | (A): Normal grief reaction
(B): Hoarding
(C): Adjustment disorder
(D): Persistent Depressive Disorder (Dysthymia) | Persistent Depressive Disorder (Dysthymia) | D | There is not enough information yet to rule out anything except Persistent Depressive Disorder (Dysthymia) in which one criterion is that the symptoms persist for at least two years. Adjustment Disorder is a possibility as the initial criteria is an emotional response to an identifiable stressor, within three months. Hoarding is another diagnosis to consider as Theodore does not want to get rid of anything that reminds him of his wife. However, it is also important to consider normal reactions to grief before finalizing a diagnosis. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,369 | Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3) | Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio | You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English. | The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss. Which approach would help the client understand that depression is an illness (i\. e., not a moral failing) stemming from difficult life events (e\. g | Which approach would help the client understand that depression is an illness (i.e., not a moral failing) stemming from difficult life events (e.g., complicated bereavement)? | Interpersonal therapy | Psychoanalytic therapy | Gestalt therapy | Person-centered therapy | (A): Interpersonal therapy
(B): Psychoanalytic therapy
(C): Gestalt therapy
(D): Person-centered therapy | Interpersonal therapy | A | Interpersonal therapy is a form of cognitive therapy based on the assumption that depression is an illness rather than a moral failing. Interpersonal therapists operate on the premise that interpersonal problems fall into four separate categories: grief and loss (eg, complicated bereavement), including trouble reestablishing social ties soon after the loss; a major life change or role transition; conflict in a valued relationship; or social isolation. Psychoanalytic therapy stresses the importance of discovering unconscious forces that drive behavior. Person-centered therapy uses the core facilitative conditions of unconditional positive regard, empathy, and genuineness. Finally, gestalt therapy focuses on successfully integrating the mind and body through present awareness. Therefore, the correct answer is (B) | counseling skills and interventions |
1,370 | Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center | The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety. | First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, "About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it." She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack. She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, "I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense." As she wipes tears from her eyes, she shares, "I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband." She tells you that she had a "bad experience" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never "get better." She also states she feels like a "bad wife and mother" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her. | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal. The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. | What action step would you recommend for the client during the first session? | Recreating the situation where the client had her first panic attack | Work with the client on identifying cognitive distortions | Use a journal to self-monitor the frequency of panic attacks | Request the client reconsider taking medication for her panic attacks | (A): Recreating the situation where the client had her first panic attack
(B): Work with the client on identifying cognitive distortions
(C): Use a journal to self-monitor the frequency of panic attacks
(D): Request the client reconsider taking medication for her panic attacks | Use a journal to self-monitor the frequency of panic attacks | C | Journaling is a helpful tool for those experiencing panic attacks to help self-monitor the frequency of their attacks. By tracking the time between attacks, a person can gain insight into the triggers that might be contributing to the attacks, as well as gain an understanding of the severity of their symptoms over time. It can also provide a sense of control and help clients identify behavioral patterns. Keeping a journal can also help track the effectiveness of any techniques used to manage panic attacks, allowing the client to make adjustments if needed. Finally, Journaling can empower individuals to take ownership of their process and make informed decisions about their care. Therefore, the correct answer is (D) | treatment planning |
1,371 | Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0) | Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa | You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive. | The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust | Which CBT technique did you use in the session summary when you responded to the husband’s statement about not feeling that his wife is attracted to him? | Radical acceptance | Guided discovery | Cognitive challenging | Downward arrow | (A): Radical acceptance
(B): Guided discovery
(C): Cognitive challenging
(D): Downward arrow | Downward arrow | D | The downward arrow technique uses the client’s own statements to follow their thought process to its roots, which usually reveals the underlying cause of why the original thought is hurtful. The client’s original thought progressed from feeling that his wife is not attracted to him to fears that they will have a miserable marriage. Identifying this underlying fear can be helpful in targeting the deeper feelings that should be of focus during therapy. Radical acceptance is not a CBT technique and focuses on accepting the situation as it is. This may be helpful in accepting that the affair did indeed happen so that they can make a decision to either move forward together or separately. Guided discovery is a CBT technique that reflects on thoughts and feelings to discover the client’s thought process. Although this situation was about discovering the client’s thought process, the downward arrow technique is the specific method for how this discovery was completed. Cognitive challenging is a technique that focuses on challenging irrational or illogical beliefs or thoughts. Therefore, the correct answer is (A) | counseling skills and interventions |
1,372 | 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 | Nadia is showing symptoms of? | Disruptive dysregulation disorder and autism | Disruptive dysregulation disorder and intellectual disability | Bipolar disorder and autism | Bipolar disorder and intellectual disability | (A): Disruptive dysregulation disorder and autism
(B): Disruptive dysregulation disorder and intellectual disability
(C): Bipolar disorder and autism
(D): Bipolar disorder and intellectual disability | Bipolar disorder and intellectual disability | D | Nadia is showing symptoms of bipolar disorder by risk taking behaviors as well as manic and depressive episodes. She is also showing intellectual development disorder with an IQ less than 70 to 75. Disruptive Mood Dysregulation disorder is ruled out as irritability is not the prominent feature. Although intellectual disability is common among individuals with autism spectrum disorder, Nadia is not showing apparent discrepancy between level of social-communicative skills and other intellectual skills. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,373 | 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. | The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes. Your client states she is currently not ready to stop drinking. You respond, “It’s up to you to decide if and when you are ready. No one can make that choice for you | Your client states she is currently not ready to stop drinking. You respond, “It’s up to you to decide if and when you are ready. No one can make that choice for you.” Which core principle of professional ethical behavior is best reflected in this response? | Justice | Autonomy | Fidelity | Veracity | (A): Justice
(B): Autonomy
(C): Fidelity
(D): Veracity | Autonomy | B | According to the ACA’s Code of Ethics (2014), there are six core principles of professional, ethical behavior: autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. This question asks you to identify the best match between your statement and an ethical principle. Conveying to the client that it is up to them to decide whether or not they stop drinking reflects the principle of autonomy. Autonomy, or “fostering the right to control the direction of one’s life” (ACA, 2014), respects the client’s independence, which supports and empowers self-determination. Veracity is truthfulness. Fidelity involves respecting commitments and honoring promises. Lastly, justice promotes fair and equitable treatment toward all clients. Therefore, the correct answer is (C) | professional practice and ethics |
1,374 | 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. | 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 might be most helpful in facilitating the client's involvement in therapy? | Provide skill sets to teach the client about how to cope with bullying. | Assignments focused on addressing bullying, encouraging your collaborative efforts. | Invite the client's parents to attend therapy to provide support and information to learn how to cope with bullying. | Consider play therapy so the client can begin talking about what is happening. | (A): Provide skill sets to teach the client about how to cope with bullying.
(B): Assignments focused on addressing bullying, encouraging your collaborative efforts.
(C): Invite the client's parents to attend therapy to provide support and information to learn how to cope with bullying.
(D): Consider play therapy so the client can begin talking about what is happening. | Consider play therapy so the client can begin talking about what is happening. | D | Play therapy is still highly effective in this age range, as playing out scenarios can help children process complex emotions, traumatic experiences, or stressors. Therapists guide the play and provide support. As children mature, verbal discussion techniques may blend with play therapy. The first step is helping a child/adolescent to open up about their experiences. Next is a therapist's job: to gain a client's trust and help them figure out an effective way to deal with the situation. Therapists specializing in assisting clients to cope with bullying can help your clients speak up about their experiences without fear of repercussions. Therefore, the correct answer is (D) | counseling skills and interventions |
1,375 | 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. | The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only communicate regarding the kids. You attempt to process with the couple what the affair means for their relationship and what events led up to the affair. During the session, the husband stops talking and looks away from his wife when she talks about how she became frustrated that her husband did not spend quality time with her prior to the affair. She thinks that this led to her seeking attention from a man outside of the couple’s relationship. The Gottmans’ four horsemen all have behavioral interventions that support the communication style | The Gottmans’ four horsemen all have behavioral interventions that support the communication style. Which would be an appropriate intervention for stonewalling? | Talk about feelings using “I” statements | Remember the partner’s positive attributes | Use empathetic listening | Take a break and then reconvene after the client is calmer | (A): Talk about feelings using “I” statements
(B): Remember the partner’s positive attributes
(C): Use empathetic listening
(D): Take a break and then reconvene after the client is calmer | Take a break and then reconvene after the client is calmer | D | Taking a break and returning to the conversation when the partner is calmer would be an appropriate behavioral response to stonewalling. Using empathetic listening is beneficial, but it does not assist the client in calming down to return to a more communicative state. Remembering positive traits and using gratitude are helpful in managing feelings of contempt, but they do not address stonewalling. Using “I” statements is helpful, but it does not put the client in a state to process thoughts and feelings because he needs to return to a calm state to engage in effective communication. Therefore, the correct answer is (B) | counseling skills and interventions |
1,376 | Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9) | Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam | You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes. | ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family | How can you best engage the client and her daughter in the early stages of treatment? | Constructing a multigenerational genogram | Summarizing key concerns and identified areas of focus | Normalizing feelings associated with the aging process | Advising against “catastrophizing” and “negative predictions” | (A): Constructing a multigenerational genogram
(B): Summarizing key concerns and identified areas of focus
(C): Normalizing feelings associated with the aging process
(D): Advising against “catastrophizing” and “negative predictions” | Summarizing key concerns and identified areas of focus | B | Summarizing the client’s key concerns and identified areas of focus would best engage the client and her daughter. The daughter is not the client; however, she presents today as a collateral contact and an individual who may impact engaging the client in treatment. Summarizing is a communication skill used to tie together various issues and feelings expressed by the client. This is helpful because it narrows the client’s identified areas of focus, helps the client feel heard, and allows the counselor to ask for corrections and clarifications. Individuals with MND have cognitive difficulties beyond the normal aging process, making answer A incorrect. Although constructing a genogram provides valuable information on the family, it is not the best way to engage the client in treatment. Giving advice does not contribute to engagement and should be reserved for safety issues and should be used sparingly, if at all, during treatment. Catastrophizing and negative predictions are cognitive distortions and irrational beliefs found in rational-emotional therapy and cognitive therapy, respectively. Therefore, the correct answer is (B) | treatment planning |
1,377 | Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation. He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else. | You are a counselor in a private practice setting. Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.” | Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.” He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly. | Which of the following interventions will help the client work through his grief? | Invite the client to bring in pictures of his father and share stories about him in session. | Invite him to begin journaling about some of his own life events that his father missed. | Invite the client to limit all reminders of his father's death to prevent triggering himself. | Invite him to think about how his life might have been different had his father lived. | (A): Invite the client to bring in pictures of his father and share stories about him in session.
(B): Invite him to begin journaling about some of his own life events that his father missed.
(C): Invite the client to limit all reminders of his father's death to prevent triggering himself.
(D): Invite him to think about how his life might have been different had his father lived. | Invite the client to bring in pictures of his father and share stories about him in session. | A | PTSD has complicated the client's ability to grieve normally so as he is able to begin grieving, it is helpful for him to begin reminiscing about his father. Individuals with persistent complex bereavement disorder (PCBD) often exhibit difficulty with this process (Criterion C3). Symptoms of PCBD include life role confusion or a diminished sense of identity without the deceased (Criterion C11) and excessive avoidance of reminders of the loss (B6). Thus, responses b, c, and d are not helpful interventions. Journaling and contemplating life events his father missed or how his life might have been different is more likely to trigger emotions related to dissatisfaction, frustration, and anger rather than acceptance of the loss. Inviting the client to avoid all reminders of the loss encourages embracing avoidance of the loss, a symptom found in both PTSD and PCBD. Therefore, the correct answer is (A) | counseling skills and interventions |
1,378 | 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. Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, "I can't do this. You tell them." Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents. You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, "We know that something is going on." He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, "We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl." You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her. The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that "did this to our daughter." The initial conversation is difficult, but you provide support as the family talks through their feelings. | 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 just exhibited great courage and growth in disclosing her situation to her parents. How should you respond to the parent's struggle in processing their daughter's pregnancy? | Provide emotional support for their experience | Remind the parents that they are here to support their daughter, and ask them to leave if they can't. | Provide psychoeducation about adolescent pregnancy | Give unconditional support to your client and address enmeshment issues in the family. | (A): Provide emotional support for their experience
(B): Remind the parents that they are here to support their daughter, and ask them to leave if they can't.
(C): Provide psychoeducation about adolescent pregnancy
(D): Give unconditional support to your client and address enmeshment issues in the family. | Provide emotional support for their experience | A | The parents have just found out that their teenage daughter is pregnant. They were unaware that she even had a boyfriend, so this news is understandably a lot for them to take in. Before you can determine how to proceed with the client, you should validate the parent's emotional reaction and allow them to have the space to process this news. Therefore, the correct answer is (D) | counseling skills and interventions |
1,379 | Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual | Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving. | Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii. | Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed. | Which goals should be included in Malik's treatment plan? | Elimination of anxiety and cultural stress | Elimination of suicidal thoughts and reduction in anxiety | Reduction of anxiety and elimination of cultural stress | Reduction of suicidal thoughts and depression | (A): Elimination of anxiety and cultural stress
(B): Elimination of suicidal thoughts and reduction in anxiety
(C): Reduction of anxiety and elimination of cultural stress
(D): Reduction of suicidal thoughts and depression | Elimination of suicidal thoughts and reduction in anxiety | B | There is no acceptable level of suicidal thoughts when considering goals for a depressed client. As a counselor, you should always strive to help your client eliminate suicidality and return to a previous level of functioning. In doing so it is likely some measure of depression will further be alleviated. Elimination of anxiety is not a realistic goal, but one can greatly reduce the anxiety they experience through various cognitive and other behavioral interventions. The reduction of stress experienced because of acculturation transitions is also a healthy goal, but given the options above, addressing suicidal thoughts must be prioritized. Therefore, the correct answer is (B) | treatment planning |
1,380 | 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. | Which of these issues take priority when working with the client? | Anxiety and difficulty focusing | Emotional distance of husband | Client's fear of dying | Ability to concentrate and forgetfulness | (A): Anxiety and difficulty focusing
(B): Emotional distance of husband
(C): Client's fear of dying
(D): Ability to concentrate and forgetfulness | Client's fear of dying | C | The client's fear of dying is the most important problem to address, as it is her primary source of distress. If not addressed, it will be difficult for her to make progress in therapy. The therapist needs to explore her fear of death, and any other related topics that are the cause her distress and panic attacks. Therefore, the correct answer is (C) | professional practice and ethics |
1,381 | 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 continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice | How would you navigate gift giving with the client? | You decline the gift because to do so would not be culturally offensive to this client. | You decline the gift because she is a talented artist and the painting is high in monetary value. | You accept the gift but explain that agency policy prohibits you from reciprocating. | You accept the gift because rejecting the gift would hurt the client. | (A): You decline the gift because to do so would not be culturally offensive to this client.
(B): You decline the gift because she is a talented artist and the painting is high in monetary value.
(C): You accept the gift but explain that agency policy prohibits you from reciprocating.
(D): You accept the gift because rejecting the gift would hurt the client. | You accept the gift because rejecting the gift would hurt the client. | D | You accept the gift because rejecting the gift would hurt the client. In weighing beneficence and malfeasance, it can be reasonably determined that rejecting the gift does more harm than accepting it. The gift represents the culmination of hard work and the return to enjoying things she loves. She credits the counselor for helping her through that journey. Therapy is coming to a close, and she has worked hard to achieve personal success. The ACA Code of Ethics (2014) states, “Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift” For this client, the gift’s monetary value is of lesser significance than what it represents. The client’s culture does not recognize small gifts as a token of respect and gratitude. Lastly, the policy for reciprocating is not necessarily a stipulation for receiving the client’s gift. Therefore, the correct answer is (D) | professional practice and ethics |
1,382 | 7 Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual | Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.
Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone | Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement. | llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.
Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone. | Millie agrees to enter your referred treatment program, a state-run facility that does not require her father's insurance as payment. Her father has left several voicemails for you, asking which program she is in and how to reach her. What is the most helpful response? | Call the father back to apologize and explain why you cannot tell him. | HIPAA prevents you from divulging this information, so you do not call back. | Contact the treatment program and tell them to call Millie's father. | You can tell him she is in detox within the state, but not the name of the facility. | (A): Call the father back to apologize and explain why you cannot tell him.
(B): HIPAA prevents you from divulging this information, so you do not call back.
(C): Contact the treatment program and tell them to call Millie's father.
(D): You can tell him she is in detox within the state, but not the name of the facility. | Contact the treatment program and tell them to call Millie's father. | C | This is the most helpful option as Millie's counselor because, while HIPAA does not permit you to divulge the information to her father since she is 18 years old and did not sign the consent form you provided, you can help facilitate communication with the family by letting the facility know the family is trying to make contact. It will be up to her new facility to then work with Millie on signing a release form and communicating with her father. Calling the father back only to tell him you cannot help him is still violating the boundaries of HIPAA since Millie did not sign consent for you to communicate with him. Simply ignoring the voicemails altogether without further action as in answer a is neglectful of the family's needs, even if you are unable to influence the outcome of their contact. Therefore, the correct answer is (D) | professional practice and ethics |
1,383 | Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed. | First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, "I keep hurting him. One day I love him, and the next day I can't look at him." She pauses and asks, "What if he leaves me? I can't deal with that." She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness. The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others. She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life. The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress. | The client's father died when she was very young. She describes her mother as having a "difficult time raising me and my brother as a single mother." The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern. | The client indicates she has trouble managing her emotions and is using self-harm as an outlet for her feelings of guilt and shame. This is also leading to the deterioration of her relationships with others. What should you consider first with the client during this first session? | Creating a structure for the client's therapy sessions | Addressing the client's difficulty with trust | Explore the reasons for the client's self-mutilating behaviors | Identifying the client's source of feeling dissatisfied with herself and others | (A): Creating a structure for the client's therapy sessions
(B): Addressing the client's difficulty with trust
(C): Explore the reasons for the client's self-mutilating behaviors
(D): Identifying the client's source of feeling dissatisfied with herself and others | Addressing the client's difficulty with trust | B | Developing a trusting rapport with the client is key to having a successful initial session. This is especially true if the client has trust issues, as progress in therapy will be severely hampered without a strong foundation of trust between therapist and client. During the initial session, the therapist must strive to create a safe and secure relationship with the client. Therefore, the correct answer is (B) | counseling skills and interventions |
1,384 | Initial Intake: Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual | Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically. | Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session. | null | ?When the counselor responded “It sounds like you have told your story many times…” she was utilizing? | Reflection of feeling | Paraphrasing | Focusing | Clarification | (A): Reflection of feeling
(B): Paraphrasing
(C): Focusing
(D): Clarification | Paraphrasing | B | Paraphrasing can be used to reiterate or clarify information. It shows the client that the counselor is listening and understands what they said. Clarification is asking the client to confirm what they said or a counselor's interpretation of what they said. A reflection of feeling focuses on the feelings of the client. In this instance there was no feelings mentioned. Focusing is a technique that happens internally where they consciously direct their attention to something in the session. Therefore, the correct answer is (C) | counseling skills and interventions |
1,385 | Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3) | Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea | You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library. | ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression. You tell the client, “Imagine waking up one morning and a miracle had occurred. You notice that your problems ceased to exist | You tell the client, “Imagine waking up one morning and a miracle had occurred. You notice that your problems ceased to exist. What would this look like for you?” This technique is associated with which one of the following? | SFBT | REBT | DBT | Person-centered therapy | (A): SFBT
(B): REBT
(C): DBT
(D): Person-centered therapy | SFBT | A | SFBT is a short-term, solution-oriented approach used to help clients improve motivation and make measurable behavioral changes. The “miracle question” is a solution-focused technique that helps clients envision their future without the problem. Person-centered therapy uses the core facilitative conditions of unconditional positive regard, empathy, and genuineness. REBT is based on the assumption that irrational or self-defeating beliefs help the client stay “stuck” and serve as barriers to change. DBT is a type of CBT that involves teaching the skills of mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Therefore, the correct answer is (A) | counseling skills and interventions |
1,386 | 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. | 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. | How can the client develop a support network to help with his disorder? | The client should be provided with information about eating disorder groups in the area for people his age. | The client cannot develop a support system for his disorder until he accepts that it is a problem. | The client should be encouraged to reach out to his church friends to provide support. | The client should be encouraged to connect with his school friends to provide support. | (A): The client should be provided with information about eating disorder groups in the area for people his age.
(B): The client cannot develop a support system for his disorder until he accepts that it is a problem.
(C): The client should be encouraged to reach out to his church friends to provide support.
(D): The client should be encouraged to connect with his school friends to provide support. | The client cannot develop a support system for his disorder until he accepts that it is a problem. | B | Since the client is in denial and does not believe he has a problem, support for bulimia is not possible. Therefore, the correct answer is (B) | counseling skills and interventions |
1,387 | Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency | The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner. | First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, "I can't believe this is happening at my age. I am all alone. What am I going to do?" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, "I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing." She describes having mixed feelings of anger, sadness, fear, and confusion. She states, "There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming." She further discloses that she is worried about having panic attacks again because "that's what happened the last time something of this magnitude happened to me." You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change. Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills. During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with "the other woman." She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what "normal" means to her. She says, "I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage." You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, "I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead." You reassure her that you are here to support her as she works through all of her difficult emotions. | null | Using an REBT approach, what irrational belief does the client hold that you plan dispute during therapy? | "Nothing I do is ever good enough." | "I am undeserving of love and happiness due to this separation." | "I must be loved and accepted by my husband in order to have value." | "I must always be strong and never show my emotions." | (A): "Nothing I do is ever good enough."
(B): "I am undeserving of love and happiness due to this separation."
(C): "I must be loved and accepted by my husband in order to have value."
(D): "I must always be strong and never show my emotions." | "I must be loved and accepted by my husband in order to have value." | C | This is an irrational belief because it suggests that the client's self-worth is inextricably linked to her relationship with her partner and his actions. This type of thinking fails to recognize that being single does not diminish her value and worth as a person, and should be addressed during the therapeutic process. Therefore, the correct answer is (C) | counseling skills and interventions |
1,388 | Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12) | Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are | You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite. | The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor | Which one of the following assessments will assist you in monitoring the severity of the client’s manic episode? | Brief Symptom Inventory | General Behavior Inventory | Patient Health Questionnaire 9 (PHQ-9) | Minnesota Multiphasic Personality Inventory (MMPI-2) | (A): Brief Symptom Inventory
(B): General Behavior Inventory
(C): Patient Health Questionnaire 9 (PHQ-9)
(D): Minnesota Multiphasic Personality Inventory (MMPI-2) | General Behavior Inventory | B | The General Behavior Inventory assesses the presence and severity of manic and depressive symptoms; therefore, it is the most appropriate tool for monitoring the severity of the client’s symptoms. The MMPI-2 can support a bipolar I or II diagnosis, but it would not be beneficial in regularly measuring the severity of symptoms. The PHQ-9 is the major depressive disorder portion of the full PHQ that can help with the diagnosis and measurement of depressive symptom severity over time. The Brief Symptom Inventory measures many areas of symptomatology and may be useful in providing support for a bipolar diagnosis, but it does not provide measurement for the severity for manic episodes. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,389 | Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0) | Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af | You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present. | You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing. You suspect that the client might have depression | You suspect that the client might have depression. Which one of the following statements is a helpful cognitive reframing of the client’s statement of “I will get frustrated and won’t enjoy playing guitar, so I won’t play at all”? | “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.” | “I should wait until tomorrow, and I’ll play guitar at 6 pm after dinner.” | “I might enjoy playing guitar; therefore, I’ll try to play for a few minutes.” | “I will play guitar when I’m ready, which is when I feel a bit more motivated.” | (A): “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”
(B): “I should wait until tomorrow, and I’ll play guitar at 6 pm after dinner.”
(C): “I might enjoy playing guitar; therefore, I’ll try to play for a few minutes.”
(D): “I will play guitar when I’m ready, which is when I feel a bit more motivated.” | “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.” | A | When considering depression, activities often seem like they will not be as enjoyable as they are in reality; therefore, it is important to try them anyway. When using cognitive reframing, it is important to consider the notion that if no changes are made, things will remain the same. Encouraging the client to remind himself that he may enjoy the simple process of playing guitar is not as relevant because it does not account for the client’s ability to effect change. The notion that the client should wait until he is “ready to play” allows space for him to find excuses not to play if he is struggling with the impacts of depression and ADHD. Although creating a plan to complete a goal can help the client in goal achievement, it likely will not empower the client to manage his present emotions and thoughts. Therefore, the correct answer is (D) | counseling skills and interventions |
1,390 | Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual | Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving. | Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii. | Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed. | Interventions, teaching deep breathing, thought stopping techniques and restructuring of negative thoughts all describe which treatment plan objective? | Malik will be able to list 5 triggers and 5 coping skills to ameliorate distress. | Malik will explore, discuss, and process experiences of trauma. | Malik will learn how to apply mindfulness and CBT when experiencing anxiety. | Malik will identify at least three needed areas of improvement and verbalize them. | (A): Malik will be able to list 5 triggers and 5 coping skills to ameliorate distress.
(B): Malik will explore, discuss, and process experiences of trauma.
(C): Malik will learn how to apply mindfulness and CBT when experiencing anxiety.
(D): Malik will identify at least three needed areas of improvement and verbalize them. | Malik will learn how to apply mindfulness and CBT when experiencing anxiety. | C | Deep breathing is a supportive mindfulness intervention that helps clients reduce anxiety independently. Thought stopping and cognitive restructuring techniques are also significant interventions used for avoiding instances of anxiety and panic or developing long-term patterns of resolving anxiety-provoking thought patterns. Answers a, b and d are all effective objectives to include in Malik's treatment plan but only answer c accurately reflects the objective that would match the listed interventions. Therefore, the correct answer is (C) | counseling skills and interventions |
1,391 | Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation. | First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is "at her wit's end" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude. Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents. Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are "mean" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like "The Flash, the superhero who is the fastest human on Earth." You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age. You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits. You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others. | The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, "tries to get along" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away. | As you develop a treatment plan, what do you identify as a significant barrier that must be addressed in order for therapy to be effective? | The client's difficulty in communicating his needs and feelings | The client's struggle with navigating different expectations between his parents' homes | The client's tendency to fantasize about having special powers | The client's frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home | (A): The client's difficulty in communicating his needs and feelings
(B): The client's struggle with navigating different expectations between his parents' homes
(C): The client's tendency to fantasize about having special powers
(D): The client's frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home | The client's struggle with navigating different expectations between his parents' homes | B | This is a treatment barrier as the client has difficulty transitioning between the two households and understanding how to behave in each home, which affects his ability to make positive changes in his life and engage in therapy. The therapist can provide guidance and support to help him navigate these expectations. By doing so, the client may be able to make progress in his therapeutic goals. This is an important step in helping the client address both his internal and external challenges. Therefore, the correct answer is (A) | counseling skills and interventions |
1,392 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Engaged Counseling Setting: Agency - Telehealth Type of Counseling: Individual | Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago. | Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9)
You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability. | Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him. | Which presenting problem would you begin to assess first and which corresponding tool would you administer? | suicidal thoughts; HDRS | suicidal thoughts; C-SSRS | panic attacks; PDSS | panic attacks; BAI | (A): suicidal thoughts; HDRS
(B): suicidal thoughts; C-SSRS
(C): panic attacks; PDSS
(D): panic attacks; BAI | suicidal thoughts; C-SSRS | B | Suicidal ideation must always be prioritized in the assessment phase of counseling as results may lead towards higher levels of care needed. The C-SSRS (Columbia-Suicide Severity Rating Scale) is the best evidence-supported tool to assess the client's needs most quickly and thoroughly. Once a client is cleared for continuing the session safely, especially while in a telehealth session, other areas like panic can then be addressed. If the client is rated high risk for suicidality, the content of the session might then shift towards making referrals either for in-person care or possibly inpatient psychiatric services. The HDRS (Hamilton Rating Scale for Depression), PDSS (Panic Disorder Severity Scale), and the BAI (Beck Anxiety Inventory) are all helpful tools that can be utilized in the assessment phase or as part of an ongoing treatment plan goal to further identify and define areas of need; they are however not considered the best options for crises interventions or specifically ruling out suicidality as the C-SSRS measures and informs history and present indicators of ideations, plans, intent and actual suicidal attempts. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,393 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express | You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex. | The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex | Based on the client’s presenting problems, all of the following would be a beneficial intervention for the girlfriend to use to support the client during sex EXCEPT: | Positive affect | Eye contact | Comfort with silence | Immediacy behaviors | (A): Positive affect
(B): Eye contact
(C): Comfort with silence
(D): Immediacy behaviors | Comfort with silence | C | Although comfort with silence can be a positive trait in a relationship, the client is still working through addressing negative self-talk and it would likely increase anxiety if silence is uncomfortable for him. Immediacy behaviors would involve the client’s girlfriend responding to what she sees the client experiencing either through reassuring statements, questions, or behaviors. Positive affect promotes a more positive environment and would likely result in a more positive experience. Eye contact demonstrates that she is present with him and attentive to him and would also promote a positive experience. Therefore, the correct answer is (C) | counseling skills and interventions |
1,394 | 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 | Which one of the following DSM-5-TR criteria is indicative of agoraphobia? | Fear of being trapped in situations in which escape is perceived as unlikely | Fear of being judged in social situations | Fear of parting with possessions despite excessive acquisition or clutter | Fear of being separated from an attachment figure | (A): Fear of being trapped in situations in which escape is perceived as unlikely
(B): Fear of being judged in social situations
(C): Fear of parting with possessions despite excessive acquisition or clutter
(D): Fear of being separated from an attachment figure | Fear of being trapped in situations in which escape is perceived as unlikely | A | Fear of being trapped in situations in which escape is perceived as unlikely is a DSM-5-TR criterion for agoraphobia. Separation anxiety disorder is characterized by separation from an attachment figure. The fear of being judged in a social situation is associated with social anxiety disorder. Hoarding disorder involves the fear of parting with possessions despite excessive acquisition or clutter. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,395 | Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual | The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
| Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major. He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested. | null | An assessment that would be most beneficial to gain initial information is? | Adult Behavior Checklist | Myers-Briggs Type Indicator | Strong Interest Inventory | NEO Personality Inventory | (A): Adult Behavior Checklist
(B): Myers-Briggs Type Indicator
(C): Strong Interest Inventory
(D): NEO Personality Inventory | Adult Behavior Checklist | A | The Adult Behavior Checklist (ABCL) is a brief, self-report checklist in which someone selects whether he/she is having difficulty in the areas of attention, mood, conduct, anxiety and worry. This would be an appropriate and non-invasive assessment for Darrel to complete. If it is indicated that Darrel is indeed unsure of his career path, the Strong Interest Inventory can help Darrel match his interests with potential education, career, and leisure activities. The Myers-Briggs Type Indicator is used to evaluate personality types to help clients better understand themselves including learning style, social interaction styles, which occupational path they may be suited for, or insight into their behaviors. The NEO is another personality inventory widely used in career and individual counseling, career development and employee training. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,396 | Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12) | Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are | You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite. | You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning | With which of the following would there be a beneficial collaboration that would require a release of PHI? | Psychiatrist | Parents | PCP | Disability resource center | (A): Psychiatrist
(B): Parents
(C): PCP
(D): Disability resource center | Disability resource center | D | The school’s disability resource center would be helpful in seeking accommodations for the client in her classes. The Americans with Disabilities Act covers most mental health disorders and could assist the client with maintaining academic progress while she is working through starting to manage bipolar disorder. The client does not currently see a psychiatrist and also has not mentioned her PCP and does not appear to see them in any way that would require collaboration. Collaboration with the client’s parents is not indicated because the client is currently living at school away from her parents. Therefore, the correct answer is (A) | professional practice and ethics |
1,397 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family | Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks. | Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance. | Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support. | Which treatment plan goals must be included in Shania's chart? | alcohol dependence and cocaine use | anxiety and trauma | all disorders listed must be treated | depression and anxiety | (A): alcohol dependence and cocaine use
(B): anxiety and trauma
(C): all disorders listed must be treated
(D): depression and anxiety | depression and anxiety | D | While all disorders may be noted in a client's chart, not all conditions qualify for working on goals in outpatient counseling. Because of the nature of a substance use disorder, when a client is actively using or has not reached remission status, it is presumed to be addressed in a substance use facility. Once the substance use moves into remission and the client is being seen in an outpatient counseling agency, that agency will have no need to directly address an active substance use disorder but will be treating mental health and subsequent effects of past substance use. Additionally, a client may have other listed disorders or conditions that can be labeled as "referred" or "deferred", not necessitating direct treatment either. But because Shania's depression and anxiety are listed disorders and are complications of past trauma, these two at least need to be included in the treatment plan. Therefore, the correct answer is (C) | treatment planning |
1,398 | 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.” | The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week. After her setback, the client states, “I’ll never control my eating | After her setback, the client states, “I’ll never control my eating.” Which of the following maladaptive styles of thinking is reflected in the client’s statement? | Self-fulfilling prophecy | Dichotomous thinking | Catastrophizing | Overgeneralization | (A): Self-fulfilling prophecy
(B): Dichotomous thinking
(C): Catastrophizing
(D): Overgeneralization | Overgeneralization | D | Overgeneralization is a maladaptive thinking style that uses one event to create a sweeping rule for all other situations. This is reflected in the client’s statement: “I’ll never be able to control my eating” The setback is one event, and the general rule for the client is that this setback means the client will never succeed at controlling her eating. Catastrophizing occurs when a person embellishes a situation in such a way that the outcome is exaggerated. (Eg, “This setback means I’m a failure at life!”) Dichotomous thinking, or black and white thinking, occurs when one engages in all-or-nothing beliefs. (Eg, “I binged after breakfast. My whole day is ruined”) Self-fulfilling prophecy is used when making future predictions and then acting in ways that guarantee the prediction comes true. (Eg, “I’ll always be defined by my weight”). Therefore, the correct answer is (B) | counseling skills and interventions |
1,399 | Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1) | Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f | You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic. | You meet with the group, and they appear to be starting to become more comfortable with one another. You noticed that throughout the past week, when you saw your clients on their unit, they were spending more time together and that they are all talking when they come in for the session. During the session, you and the clients discuss past experiences that led to them engaging in the crimes that led to their incarceration. During this conversation, client 1 is talking about his father and how he killed a pedestrian while driving. Client 4 then asserts that client 1’s father is going to hell for killing someone. You cut off client 4 and redirect the attention back to client 1 | Which of the following would demonstrate appropriate use of “cutting off” for client 4? | Ignore what was said by client 4 because you do not want to give it attention and reinforce his desire for conflict. | Remind client 4 that what he said was against the goals of the group and that he might be asked to leave if he continues. | Engage with client 4 in conversation about the beliefs he holds and then return to client 1. | Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue. | (A): Ignore what was said by client 4 because you do not want to give it attention and reinforce his desire for conflict.
(B): Remind client 4 that what he said was against the goals of the group and that he might be asked to leave if he continues.
(C): Engage with client 4 in conversation about the beliefs he holds and then return to client 1.
(D): Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue. | Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue. | D | Cutting off would be telling client 4 that what he said was not acceptable in the group setting and then redirecting back to client 1. Engaging with client 4 about his beliefs would likely cause more harm, and this would not be a helpful intervention. You should not ignore client 4’s statements because you want to support client 1 and set a precedent for what is acceptable in the group. Telling client 4 that what he said was against the group goals is helpful; however, threatening expulsion from the group does not support client 4 and might not be indicated at this point. Therefore, the correct answer is (C) | counseling skills and interventions |
1,400 | 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 one of the following anxiety rating scales includes a version that allows a parent to fill out scales on their child? | The Generalized Anxiety Disorder-7 (GAD-7) | Hamilton Anxiety Rating Scale (HAM-A) | Patient Health Questionnaire (PHQ-9): Parent Report | The abbreviated Conners Parent Rating Scale (CPRS-HI) | (A): The Generalized Anxiety Disorder-7 (GAD-7)
(B): Hamilton Anxiety Rating Scale (HAM-A)
(C): Patient Health Questionnaire (PHQ-9): Parent Report
(D): The abbreviated Conners Parent Rating Scale (CPRS-HI) | The Generalized Anxiety Disorder-7 (GAD-7) | A | The GAD-7 is an anxiety rating scale that includes an instrument for use with adolescents and a version that allows a parent to fill out scales on their child. The GAD-7 is a seven-item self-administered instrument used to identify some of the criteria for general anxiety disorder and to determine symptom severity. The CPRS-HI is a questionnaire that asks parents about symptoms related to attention-deficit hyperactivity disorder. There is also a version for teachers. The HAM-A is a 14-item scale that measures the severity of anxiety symptoms. It does not have a version for parents to complete on their child. The PHQ-9: Parent Report is used to measure depression rather than anxiety. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
Subsets and Splits