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1,401 | 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. The client has recently become eligible for special education services, including an Individualized Education Program (IEP) | The client has recently become eligible for special education services, including an Individualized Education Program (IEP). Which one of the following federal laws mandates that an IEP must be completed within 30 days of eligibility? | Title VII of the Civil Rights Act of 1964 | Section 504 of the Rehabilitation Act of 1973 | Individuals with Disabilities Education Act (IDEA) | Title II of the Americans with Disabilities Act (ADA) | (A): Title VII of the Civil Rights Act of 1964
(B): Section 504 of the Rehabilitation Act of 1973
(C): Individuals with Disabilities Education Act (IDEA)
(D): Title II of the Americans with Disabilities Act (ADA) | Individuals with Disabilities Education Act (IDEA) | C | For students in institutions receiving federal funding, three federal laws protect the rights of students with disabilities: IDEA, Section 504 of the Rehabilitation Act of 1973, and Title II of the ADA. Of the three, IDEA is the only law that mandates an IEP (to be completed within 30 days of eligibility) to provide a free appropriate public education in the least restrictive environment. An IEP is a written document that identifies the specialized instruction and servicesthat an individual receives. Section 504 of the Rehabilitation Act of 1973 is a civil rights law, as opposed to IDEA, which is a federal special education law. Section 504 offers accommodations for students with a mental or physical impairment that interferes with their learning. The ADA offers civil rights protections for all individuals with disabilities. Title VII of the ADA prohibits state and local governments from discrimination, which applies to federally funded public schools. Therefore, the correct answer is (B) | professional practice and ethics |
1,402 | Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency | The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene. | First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection. Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered. Sixth session You and your intern, who has never facilitated a group, meet five weeks after intake with the group members. One of the members shows up late to the group despite knowing the norms and rules. This member is from a Hispanic background. One of the other members, an African-American woman, says angrily, "You're wasting our time when you arrive late to every session. We have to pause for you. I have anxiety and need help. If you do not need help from the group, why don't you leave!" The Hispanic woman starts to cry and says, "Mind your business. I'm taking care of my dying mother and also have anxiety, so shut up!" You have to intervene as other members are getting frazzled and upset. You ask the intern to carry on with the group as you ask the two members to step outside. | null | Which therapeutic approach may work best with a group whose members are working on anxiety issues? | Jungian therapy | Cognitive-behavioral therapy | Contextual therapy | Existential therapy | (A): Jungian therapy
(B): Cognitive-behavioral therapy
(C): Contextual therapy
(D): Existential therapy | Cognitive-behavioral therapy | B | The basis of this therapy is that thoughts drive one's feelings and behaviors rather than external events, people, or circumstances. As one changes, therefore, thoughts can feel better despite the situation or what one does or does not control. This is most helpful. Therefore, the correct answer is (B) | treatment planning |
1,403 | Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, "It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now." The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control. | First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the "doctors are missing something" for years. She "feels sick all the time" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the "lack of care" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation. You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career. Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports "battling anhedonia." It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips. You state to the client, "It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?" The client replies, "Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up." You ask the client, "Have people actually said anything to you about your weight?" She responds, "No, but I can tell they're thinking it." As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment. Tenth session It's been two and a half months since you first started seeing the client for weekly therapy sessions. Today, your client appears calm and relaxed. You review her progress and highlight her areas of growth since the start of therapy. The client states that she feels more empowered to challenge her negative thoughts and is able to recognize when her anxiety is beginning to spiral. She has been using the coping skills she learned in the previous sessions to manage her stress levels more effectively. The client also reports a weight loss of 5 pounds since beginning therapy, which she is pleased with and attributes to the mindfulness techniques she has been practicing. You discuss her weight loss and the importance of mindful eating practices. You explain to the client that weight loss is a secondary outcome of therapy and that it is more important to focus on living a healthy lifestyle than a number on a scale. The client expresses her understanding and appreciation for the guidance. When you ask her to rate her level of anxiety, she indicates that she is much less anxious than when she first started therapy. Her preoccupation with illness has decreased, though it has not gone away completely. She reports that her colleagues have noticed the change in her attitude and confidence. She is able to stay present and focus on her job, without constantly worrying about negative judgement from her co-workers. She tells you that she has been keeping up with the journaling homework that you assigned in a previous session and it has been a helpful outlet for her to express her thoughts. She has also been practicing progressive muscle relaxation during her breaks at work and after she gets home in the evenings. The client is still drinking wine to help her relax, but you have determined that her alcohol use does not warrant clinical intervention. You discuss spacing out your sessions and she agrees to try meeting with you twice a month. At the end of the session, she asks if you could email her a copy of her therapy records so that she can refer back to them periodically in order to continue making progress. | The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life. She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a "charge nurse." She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition "because those issues run in my family." There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. | How would you best demonstrate active listening skills in this session? | "From what you have told me and what I've observed in our sessions, you've made some significant progress in therapy. How would you feel about spacing out our sessions?" | "It sounds like you're doing really well. You must be proud of yourself for all of your hard work!" | "That's great that you've lost weight. I know it's been a struggle for you, and I'm glad the mindfulness exercises have been so helpful." | "I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others." | (A): "From what you have told me and what I've observed in our sessions, you've made some significant progress in therapy. How would you feel about spacing out our sessions?"
(B): "It sounds like you're doing really well. You must be proud of yourself for all of your hard work!"
(C): "That's great that you've lost weight. I know it's been a struggle for you, and I'm glad the mindfulness exercises have been so helpful."
(D): "I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others." | "I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others." | D | Active listening is an important part of any therapeutic session. It involves showing empathy, understanding and respect for the client by actively attending to their verbal and non-verbal communication. When using active listening, the therapist paraphrases what the client has said, mirrors their emotions and shows non-judgmental interest in their experience. Therefore, the correct answer is (C) | counseling skills and interventions |
1,404 | 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. | Why is anxiety disorder listed as primary before major depression? | Anxiety is the primary underlying stressor | You cannot work on depression before anxiety | Anxiety is more clinically serious | Diagnoses must be listed alphabetically | (A): Anxiety is the primary underlying stressor
(B): You cannot work on depression before anxiety
(C): Anxiety is more clinically serious
(D): Diagnoses must be listed alphabetically | Anxiety is the primary underlying stressor | A | Anxiety is the underlying condition which exacerbates Jonny's ability to cope, which the develops into a depressive state. Jonny has no evidence in this case of experiencing depression isolated from heightened anxious states. It is assumed that if anxiety is properly treated, depressive episodes will be eliminated or reduced. Answers a) through c) are incorrect statements. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,405 | Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School | The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say "hi," and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date. | First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a "toddler-like" voice to sit in the seat. The mother tells you that the client is becoming increasingly "violent" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him "the education he deserves". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses. You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process. | The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. | Which is the most effective strategy to increase the parents' feelings of empowerment? | Family dynamics training | Parent education programs | In-home intervention by a specialist | Medical referral | (A): Family dynamics training
(B): Parent education programs
(C): In-home intervention by a specialist
(D): Medical referral | Parent education programs | B | Such programs have been shown to reduce parental anxiety and increase parental feelings of empowerment. Therefore, the correct answer is (B) | counseling skills and interventions |
1,406 | Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual | Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly. | History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine. | null | When Autumn sat down, she noticed some files of some other students in front of the counselor. Autumn suddenly stated that she had to go and left the counselor's office. Although Autumn could only read the names and not see the content of the files, this is a violation of the ethical code regarding? | Confidentiality | Providing information to third parties | Supervision | Trust | (A): Confidentiality
(B): Providing information to third parties
(C): Supervision
(D): Trust | Confidentiality | A | The counselor seems to have violated the confidentiality of other students which goes against the ethical codes B1c. Respect for Confidentiality and B6b Confidentiality of Records and Documentation. Although this may be an issue to be addressed in supervision, it is not a violation of supervision standards. Providing information to third parties sometimes occurs when information is requested by third party payors. This must be authorized by the client. Although there is not ethical code for trust, seeing the files on the counselor's might affect Autumn's feelings of trust. Therefore, the correct answer is (C) | professional practice and ethics |
1,407 | Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3) | Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg | You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers. | The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week. The client’s parents have offered you dinner every week since you have started therapy with the client | The client’s parents have offered you dinner every week since you have started therapy with the client. All of the following are ethical considerations regarding gifts EXCEPT: | The reason the parents are offering the meal. | Accepting the meal may count as compensation to the clinician for services rendered. | Declining a meal might be offensive due to the client’s culture. | The monetary impact of accepting the meal. | (A): The reason the parents are offering the meal.
(B): Accepting the meal may count as compensation to the clinician for services rendered.
(C): Declining a meal might be offensive due to the client’s culture.
(D): The monetary impact of accepting the meal. | Accepting the meal may count as compensation to the clinician for services rendered. | B | Compensation for services would fall under the ACA Code of Ethics section on bartering rather than ethical considerations for gifts (ACA, 2104). Bartering would involve further consideration and planning to include a written contract and is not being demonstrated in the offering of a meal. It is important to consider the cultural implications of declining a gift if it negatively affects the counseling relationship. Monetary impact is important because you would not want to regularly accept meals if it puts a financial strain on your client’s family. It is also important to consider the motive for giving the gift because the parents may have expectations for a gift in return, which may complicate or strain the counseling relationship. Therefore, the correct answer is (A) | professional practice and ethics |
1,408 | Initial Intake: Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual | Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
| Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.
History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.
The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments. | null | Carl and Lori have decided that they want to work out their marital issues. A technique that the counselor should not use is? | Allowing the couple to argue so they can release their feelings | Video tape couple's therapy sessions to playback | Behavioral therapy | A non-directive client Rogerian approach | (A): Allowing the couple to argue so they can release their feelings
(B): Video tape couple's therapy sessions to playback
(C): Behavioral therapy
(D): A non-directive client Rogerian approach | Allowing the couple to argue so they can release their feelings | A | It is important for the counselor to prevent the heightening of emotions to the point where therapy cannot be accomplished. If the counselor feels that tension is escalating to the point of an argument, the role of the counselor is to bring down the emotions and guide the couple to effective communication techniques. Additionally, it is to help the couple gain insight into their relationship patterns and to provide techniques to improve relationship functioning. By videotaping couple interactions and replaying this in sessions, couples gain more insight on how they may appear to the other person. Other couples may find a more non-directive approach useful, where the focus is on listening to one another and clarifying intention. Lastly, behavior therapy using positive reinforcement and rewarding behavior when one person in the couple does something that the other one finds positive may be effective. Therefore, the correct answer is (A) | treatment planning |
1,409 | 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. Ninth session Logan arrives at the session a few minutes late and apologizes. He says that he was outside playing kickball with his class. He reports that he has been feeling better about being in school lately. His classmates are friendlier to him, or at the very least, "they don't bother me so much," He is now eating lunch back in the lunchroom. He is learning to play soccer and plans to ask his parents if he can join the summer league. Next, you call Logan's mother and share his progress in counseling with her. Finally, you examine Logan's care plan and assess for any changes needed. Logan's progress in counseling has been notable as he has demonstrated increased social engagement and involvement in extracurricular activities. It appears that the therapeutic interventions implemented have successfully addressed his initial concerns regarding social anxiety and peer relationships. In addition, Logan's newfound interest in soccer and desire to join a summer league further demonstrates his willingness to engage with peers and develop new skills. In conversation with Logan's mother, you emphasize the importance of fostering a supportive home environment to encourage Logan's growth and self-confidence. The mother expresses gratitude for the improvements in her son's well-being and commits to facilitating Logan's involvement in the summer soccer league. Additionally, she agrees to maintain open communication with the counselor to address any potential concerns that may arise in the future. Upon reviewing Logan's care plan, the counselor determines that the current therapeutic goals and interventions remain appropriate and relevant to Logan's ongoing progress. However, it may be beneficial to introduce supplementary strategies to further enhance his self-esteem and resilience and promote effective communication and problem-solving skills. By doing so, Logan will be better equipped to navigate any challenges that may emerge as he develops and maintains positive relationships with his peers. After the session, you receive a phone call that your wife has passed away. In the midst of the sudden loss of your beloved wife, you find yourself struggling to maintain your usual level of composure, which is understandable, feeling overwhelmed and emotionally drained during this difficult time. Being a therapist, you recognize the weight of your emotional burden and decide to reach out to your supervisor to discuss your struggles. After a heartfelt conversation, you feel a sense of relief and connection with your supervisor, who has provided you with support and understanding. As the conversation draws to a close, you make an unexpected request of your supervisor: that she attend your wife's memorial and wake so that she can meet your family and share in the memories of your loved ones. This request may seem a lot to ask, but you feel comforted by the thought of having someone close to you share in this challenging time. You also ask if she can take over your caseload as you deal with your wife's passing. | 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 are the steps in managing the transitional nature of terminating a client involved with bullying as they approach ending therapy? | Summarize where they were when they began therapy and the changes that have occurred. | Complete an overview of what they have learned and the changes they have accomplished. | Ask the client what they have learned and what aspects of their past history still need to be addressed. | Explore further problems they might encounter going forward as they progress. | (A): Summarize where they were when they began therapy and the changes that have occurred.
(B): Complete an overview of what they have learned and the changes they have accomplished.
(C): Ask the client what they have learned and what aspects of their past history still need to be addressed.
(D): Explore further problems they might encounter going forward as they progress. | Complete an overview of what they have learned and the changes they have accomplished. | B | Reiterate with this client to understand how this role of the victim impacts their lives and teach coping skills for moving forward, such as assertive communication and boundary-setting. In addition, some victims of bullying benefit from support groups or group therapy as a part of transitioning through therapy, in which people who have experienced similar types of victimization can support one another in healing. Therefore, the correct answer is (B) | counseling skills and interventions |
1,410 | Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School | The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say "hi," and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date. | First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a "toddler-like" voice to sit in the seat. The mother tells you that the client is becoming increasingly "violent" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him "the education he deserves". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses. You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process. Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him "good job." The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others. Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan. Ninth session The client's one-on-one aide presents to this session with the client. The client is crying and having difficulties following the aid's directives in the hallway. You walk into the hall and show the client a picture with "a quiet sign." You open your door, and he reluctantly walks in and begins to kick the toy bins. You show him the "no" visual sign and shake your head no. You sit on the floor quietly until he joins you on the floor. You pull out a deck of visual cue cards and place them in front of him. He points to a picture of a boy being mean to another classmate, then starts to cry harder. You allow some extra time for the client to process his emotions. You then explain to him that it is not okay to kick the toy bin, and that he can use his words or draw pictures of what he feels instead. You provide reassurance that you are there to help him learn how to control his feelings in a better way. You then select some calming activities such as squeezing the stress ball and playing a matching game. As he begins to gain control of his emotions, you reinforce positive behaviors with verbal praise and approval. Throughout the session, you actively listen and provide opportunities for him to express himself in whatever manner is comfortable to him. You end the session by drawing a picture of yourself and your client, with both of you smiling together. You explain that this is what happens when you work together to find positive ways to cope with emotions. | The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. | What best demonstrates your use of unconditional positive regard? | Assisting the client in focusing on a life story that is divergent from the problem-saturated story narrative | Understanding and sharing the feelings of the client, expressed through body language, eye contact, and general sensitivity | Supporting the client's expressions without interrupting and engaging in active observation | Prompting engagement of the intellectual, physical, spiritual, and emotional self in an active way in session using psychodrama, thereby allowing the client to learn from the moment. | (A): Assisting the client in focusing on a life story that is divergent from the problem-saturated story narrative
(B): Understanding and sharing the feelings of the client, expressed through body language, eye contact, and general sensitivity
(C): Supporting the client's expressions without interrupting and engaging in active observation
(D): Prompting engagement of the intellectual, physical, spiritual, and emotional self in an active way in session using psychodrama, thereby allowing the client to learn from the moment. | Supporting the client's expressions without interrupting and engaging in active observation | C | Although the description has been adjusted for non-verbal communication, this describes a technique called "unconditional positive regard". Therefore, the correct answer is (A) | counseling skills and interventions |
1,411 | Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0) | Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through | You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational. | book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends. During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately | During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately. When considering fees, which of the following is the most appropriate response when the payment amount for a session causes economic hardship for the client and they are unable to pay? | The clinician will inform the client about the use of a collection agency in the process of obtaining informed consent and will seek support from the agency when collection is needed. | The clinician will write off the session as pro bono because this would best support the client. | The clinician will use a collection agency if fees cannot be paid. | The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent. | (A): The clinician will inform the client about the use of a collection agency in the process of obtaining informed consent and will seek support from the agency when collection is needed.
(B): The clinician will write off the session as pro bono because this would best support the client.
(C): The clinician will use a collection agency if fees cannot be paid.
(D): The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent. | The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent. | D | The most ethical consideration according to the ACA Code of Ethics is providing an opportunity for the client to make a payment prior to seeking a collection agency (ACA Governing Council, 2014). Using a collection agency is ethical if the client is informed of this in the informed consent process and if they have been provided a chance to pay the fees. Writing off the sessions as pro bono should not be the first consideration because you want to settle on a payment rate that the client can pay prior to considering providing services for free. Therefore, the correct answer is (C) | professional practice and ethics |
1,412 | 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. | 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." | Which best describes the diagnostic criteria for a manic episode? | Symptoms of the mood change are noticeable by other people, but the timing is dependent on the severity. | Symptoms of the mood change must last at least four days. | Symptoms of the mood change must last at least two weeks. | Symptoms of the mood change must last at least one week or require hospitalization. | (A): Symptoms of the mood change are noticeable by other people, but the timing is dependent on the severity.
(B): Symptoms of the mood change must last at least four days.
(C): Symptoms of the mood change must last at least two weeks.
(D): Symptoms of the mood change must last at least one week or require hospitalization. | Symptoms of the mood change must last at least one week or require hospitalization. | D | To fulfill the criteria of a manic episode, the duration of symptoms must be present at least one week, and the symptoms must be severe enough to cause "marked impairment in functioning" or "necessitate hospitalization". If the symptoms are severe enough to warrant hospitalization, the duration does not matter. If the client was hospitalized while experiencing the "high energy" symptoms, this communicates the level of severity, and you are looking at a manic episode. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,413 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual | Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling. | Diagnosis: Adjustment disorder with anxiety (F43.22)
You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions. | Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it. | Given Taylor's level of distress in the first session, how should you proceed? | Validate her feelings | Justify her reaction with words of approval | Remain silent and offer her a tissue | Challenge her irrational beliefs | (A): Validate her feelings
(B): Justify her reaction with words of approval
(C): Remain silent and offer her a tissue
(D): Challenge her irrational beliefs | Validate her feelings | A | The practice of validating your client's feelings is not the same as justifying their thought process or approving of their reaction to their problem. Validation of feeling is the quickest and most effective way to gain your client's trust and show that you will help them resolve their issue and reduce their stress while showing compassion and understanding for their perceptions. Your job will be to work with them on identifying cognitive distortions and challenge them on their own. Silence has an important function in the listening process, but your client has just told you they feel no one cares and has concluded their sharing for the moment. It is appropriate to respond at this moment in this counseling interaction. Offering someone a tissue while they are crying can be considered a disruption in their emotional process, signifying, "here is a tissue, so you can stop crying". The counselor should always have tissues available or provide them when asked. Therefore, the correct answer is (D) | counseling skills and interventions |
1,414 | Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency | Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age. | First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become "a nuisance for his babysitter, especially during bedtime." Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that "something bad will happen" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious. You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is "boring." However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines "all the ways they could be hurt" while they are not with him. You say, "I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better." You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions. | Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. | Of the following, which would be the most decisive factor in determining whether to self-disclose during this session? | The correlation of the therapist's experience with that of the client | The specific goals of the session | The severity of the client's symptoms | The client's age and maturity level | (A): The correlation of the therapist's experience with that of the client
(B): The specific goals of the session
(C): The severity of the client's symptoms
(D): The client's age and maturity level | The specific goals of the session | B | In any situation where a therapist is considering self-disclosing, it is important to consider the specific goals of the session and determine whether self-disclosure will be of benefit in achieving them. In this case, the primary goal would be to help Michael and his parents understand the cause of his distress and develop strategies to address it. Self-disclosure may help build a connection between therapist and client, as well as providing a practical example of how to cope with anxiety. Therefore, the correct answer is (A) | professional practice and ethics |
1,415 | 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. | You know a psychologist in a previous agency you have worked for who is trained in conducting ADHD testing, but his services are not free. You offer Shania a referral for ADHD testing and mention the service costs. Shania gets very upset. How should you respond? | "I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options." | "There's nothing to be upset about. When you're ready you can call him." | "Never mind, don't worry about it, so sorry! Maybe I can get him to do it pro bono." | "Shania, everything is going to be okay. Everything happens for a reason." | (A): "I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options."
(B): "There's nothing to be upset about. When you're ready you can call him."
(C): "Never mind, don't worry about it, so sorry! Maybe I can get him to do it pro bono."
(D): "Shania, everything is going to be okay. Everything happens for a reason." | "I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options." | A | The best way to respond to Shania for upsetting her is to simply apologize. She is clearly either upset she will be unable to pay for services she wants, or frustrated you made the suggestion knowing her financial situation. Either way, showing your swift condolences is the quickest road to helping her lower any defenses and continue sharing her feelings with you. Answer b) is invalidating, answer c) is placating to her sorrowful state while also offering to break professional boundaries to accommodate her, and answer d) while sounding positive to some is in fact generalized shallow encouragement. Therefore, the correct answer is (A) | professional practice and ethics |
1,416 | Initial Intake: Age: 15 Sex: Non-binary Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual | Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room. | Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.” | null | The best referral for the counselor to make after the second session is? | Nothing else currently | Psychological testing | Group therapy | Psychiatric consult | (A): Nothing else currently
(B): Psychological testing
(C): Group therapy
(D): Psychiatric consult | Group therapy | C | Shar's comments of not feeling like they belong, along with their positive outlook from knowing they are "not alone" shows that they may benefit most from group counseling at this time. Psychological testing or a psychiatric consult do not seem necessary currently. Individual therapy alone may be okay, but the addition of group therapy seems warranted at this time so that Shar can have a feeling of belonging. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,417 | Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20) | Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam | You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together. | ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake | Given the client’s treatment history, which one of the following would provide you with a multidimensional biopsychosocial assessment to determine if outpatient counseling is an appropriate level of care? | National Institute on Drug Abuse (NIDA) screening tool | Prevention and Early Intervention (PEI) criteria | Early Periodic Screening, Diagnosis, and Treatment (EPSDT) standards | American Society of Addiction Medication (ASAM) guidelines | (A): National Institute on Drug Abuse (NIDA) screening tool
(B): Prevention and Early Intervention (PEI) criteria
(C): Early Periodic Screening, Diagnosis, and Treatment (EPSDT) standards
(D): American Society of Addiction Medication (ASAM) guidelines | American Society of Addiction Medication (ASAM) guidelines | D | ASAM guidelines can be used to assess a client’s level of care and ensure that counselors are providing integrated, seamless, and ongoing service planning. The client began outpatient treatment after prematurely leaving inpatient therapy. ASAM uses a multidimensional approach that considers the biopsychosocial needs of each client, including substance dependency and withdrawal, to determine placement. PEI criteria are unrelated to substance use and instead provide placement for older adults at risk for developing severe mental disorders. EPSDT standards support the comprehensive health needs of children younger than age 21 who receive public health insurance. Finally, the NIDA screening instrument is used to determine an individual’s level of risk associated with substance use. Depending on the risk level, the provider will advise the patient on their drug use, assess their readiness to change, arrange for a referral, or continue to offer support. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,418 | Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine | Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns. | Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed. |
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation. | What tool can help you learn more about Leah's reported "impulsivity"? | Adult Needs and Strengths Assessment (ANSA) | CBT thought record | Young Schema Questionnaire (YSQ) | Adult ADHD Self-Report Scale | (A): Adult Needs and Strengths Assessment (ANSA)
(B): CBT thought record
(C): Young Schema Questionnaire (YSQ)
(D): Adult ADHD Self-Report Scale | CBT thought record | B | A Cognitive Behavioral Therapy thought record can help both you and Leah understand how a triggering event makes her feel, followed by what automatic thoughts Leah has in the moment and how she responds to situations with her behaviors. The record further helps Leah develop insight into her underlying distorted core beliefs and challenges her to develop healthier thought processes while also reducing her maladaptive reactions to stressful stimuli. This can help inform the diagnostic process during intake as well as be applied later in counseling. The ANSA is a comprehensive tool used for clients and treatment teams to score progress and goals and helps determine appropriate level of care and quality improvement; it is primarily only used as insurance requirements dictate and can be useful in the intake process but will not provide any details regarding Leah's behaviors as it is there for you to mark down your perspectives of her functioning based on information you already have. The YSQ is related to long-term personality deficits and is conducted when applying schema therapy interventions; this can be useful as a treatment intervention but will not target a better understanding of how Leah behaves impulsively and her reasons. There is no evidence to suggest Leah struggles with ADHD, as impulsivity can be present in adults without ADHD. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,419 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0) | Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso | You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being. | The client reports that he has been sleeping more than usual and that this is affecting his ability to get to work on time. He reports that his boss started noticing his tardiness and has given him a verbal warning. Combined with the fear of losing his job, he expressed worry regarding increased conflict with his girlfriend and feeling more “on edge.” You were a supervisor in a previous job and have experience supervising employees who are tardy | You were a supervisor in a previous job and have experience supervising employees who are tardy. What should you do to support this client with improving his situation at work? | Provide the client with psychoeducation on sleep hygiene. | Encourage the client to explain his struggle with managing sleep to his supervisor in order to increase the supervisor’s empathetic response. | Tell the client about your experience as a supervisor and ways that you supported employees in improving attendance. | Reinforce the message that the client needs to improve his attendance or his job may be affected further. | (A): Provide the client with psychoeducation on sleep hygiene.
(B): Encourage the client to explain his struggle with managing sleep to his supervisor in order to increase the supervisor’s empathetic response.
(C): Tell the client about your experience as a supervisor and ways that you supported employees in improving attendance.
(D): Reinforce the message that the client needs to improve his attendance or his job may be affected further. | Provide the client with psychoeducation on sleep hygiene. | A | Personal experience may be helpful in providing insight from the point of view of a supervisor; however, the main focus should be on sleep hygiene because this is the issue that is affecting the client’s functioning. Encouragement to talk to their supervisor would not solve their problem with sleep, encourages the client to disregard the causative issue, and may cause more issues at work. A counselor should be aware of their own personal experiences and how they may affect objectivity. Therefore, the correct answer is (C) | professional practice and ethics |
1,420 | Initial Intake: Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual | Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
| Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.
History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.
The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments. | null | All of the following statements are true regarding counseling, except? | It would be an ethical breach to take sides in this situation. | At the onset of couple's counseling, the counselor must clearly define roles in the counseling relationship. | The counselor should respond that they are both wrong. | The couple is considered the client. | (A): It would be an ethical breach to take sides in this situation.
(B): At the onset of couple's counseling, the counselor must clearly define roles in the counseling relationship.
(C): The counselor should respond that they are both wrong.
(D): The couple is considered the client. | The counselor should respond that they are both wrong. | C | It would not be appropriate for the counselor to indicate who is right or wrong. It is up to the counselor to help the couple to communicate with one another. According to ethical standards, the counselor must clearly define roles at the onset of counseling, which includes the understanding that the couple is considered the client in marital counseling. Taking sides in couple's counseling is unethical and can damage the therapeutic process. Therefore, the correct answer is (B) | professional practice and ethics |
1,421 | Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately. | You are a counselor in a private practice setting. Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.” | Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose. | Considering the information provided, which referral should you make first for this client before any other? | Refer him to a psychologist for mental health testing prior to beginning treatment | Refer him to a psychiatrist for evaluation and medication management | Refer him to his family physician for a complete physical | Refer him to a community group to help build relationships | (A): Refer him to a psychologist for mental health testing prior to beginning treatment
(B): Refer him to a psychiatrist for evaluation and medication management
(C): Refer him to his family physician for a complete physical
(D): Refer him to a community group to help build relationships | Refer him to his family physician for a complete physical | C | Counselors are not medical experts but are expected to recognize physical symptoms of stress and substance use that may need to be evaluated. The client complains of increasing stress and substance use, as well as recent chest and shoulder pain, which should be evaluated by a medical professional prior to beginning a course of treatment that may increase the client's stress. The client does not currently need referral to psychology or psychiatry. Licensed counselors in most states have the ability to determine diagnosis and treat without oversight. Clients with BPD may sometimes be treated with medications but while the client is using recreational substances and pain medication, other medications should not be recommended. If the client is interested in medication for treatment of BPD and is willing to discontinue his use of other substances, psychiatry will be an effective future referral. The client's personality traits have made relationships difficult so referral to a group aimed at forming relationships with other healthy adults is not likely to be effective at this time. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,422 | Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues. He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg. | You are a counselor in a community agency setting. Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports. | Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done. | Given the information provided, what should the counselor focus on during the initial part of the session? | The client's need to have his wife help him see another perspective | The client's inability to express regret or remorse for his actions | The client's feelings about his job and whether he is truly happy in it | The client's feelings about himself and how others view him | (A): The client's need to have his wife help him see another perspective
(B): The client's inability to express regret or remorse for his actions
(C): The client's feelings about his job and whether he is truly happy in it
(D): The client's feelings about himself and how others view him | The client's feelings about himself and how others view him | D | The client's reaction to his supervisor highlights his feelings about himself and how others view him and is the most important area to focus on for this part of the session. The client's reaction to his supervisor is indicative of people with NPD or narcissistic traits. These individuals tend to have a very fragile self-esteem which makes them extremely sensitive to criticism, making them feel ashamed, humiliated, and that they have no value at all. The client's inability to understand another perspective without help and his difficulty expressing regret or remorse are also indicative of people with NPD or narcissistic traits. Because this client possesses insight, it is most helpful to work with him on understanding how his feelings about himself and others' perceptions of him impact his self-esteem. Helping the client to understand his self-esteem as the problematic factor in his relationship with himself and others, will later allow him to work on improving his ability to empathize and acknowledge potential or actual mistakes without injury to his self-esteem. The client's current job is not a factor in this event; it is the relationship between the client and the criticism that the client has internalized into a self-esteem injury. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,423 | Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual | Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject. | Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it. |
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her. | You ask Mary what she values most. How will knowing this information be useful? | To better understand what clients care about in general | Helping Mary say it out loud will motivate her to change | Treatment plan goals can be prioritized based on her values | Use as motivation in case she elects to quit therapy | (A): To better understand what clients care about in general
(B): Helping Mary say it out loud will motivate her to change
(C): Treatment plan goals can be prioritized based on her values
(D): Use as motivation in case she elects to quit therapy | Treatment plan goals can be prioritized based on her values | C | Mary will be more likely to commit to her treatment plan goals and follow through with underlying objectives if they are structured around what is most important to her in the end. Mary already knows what she values; it is unlikely making an audible declaration will affect her actual behaviors without working regularly on interventions. Using this information to manipulate her decisions is unethical. Therefore, the correct answer is (C) | treatment planning |
1,424 | 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. Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client. When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being "very mean" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is "miserable." She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a "broken home" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife. Sixth session You have seen the client every week since the initial intake. During today's session, the client tells you she has written a suicide note and left it in her room. Her mother is waiting in the lobby for the session to end. You tell the client you must bring her mother into the session and discuss the suicide note. You explain to the client that her mother's presence is necessary to explore and understand why the suicide note was written. The client expresses frustration and says, “You can’t bring my mom in here! She won’t understand why I wrote the note!” You empathize with her feelings, but also explain that it is important to discuss the reasons for writing the suicide note with her mother present. You reassure the client that you will guide the conversation to explore why she wrote the note and support her in addressing any underlying issues. You explain that understanding these reasons is an essential step toward moving forward and developing healthier coping strategies. The client reluctantly agrees, but insists on speaking with you alone first before bringing her mother into the session. You emphasize that it is important for her to be honest about her emotions and to talk about her experiences in order to identify the root cause of her distress. Throughout the conversation, you provide validation and affirmation in order to create a safe space for her to express her feelings. You remind her that she does not have to face the situation alone, and that you can work together to find a way forward. Once the client has had an opportunity to share her thoughts and feelings, you ask if she is ready for you to invite her mother in. She agrees, and the mother joins you in session. You explain to the mother that her daughter wrote a suicide note and that the two of you have been discussing the suicide note and why it was written. You emphasize that your goal is to better understand the circumstances leading up to this situation, so that you can work together to find a way forward. You state that your primary focus is on finding solutions, rather than assigning blame or judgment. The mother looks at you in disbelief and says, "What do you mean, she wrote a note saying she was going to kill herself? What are we doing here? I'm paying you to help my daughter, not make things worse!" She grabs her daughter's hand and storms out, after expressing her anger loudly the whole way to her car. You are unsure of how to proceed, so you discuss the case with your supervisor. Your supervisor listens and notes your concerns, offering advice and guidance on better handling the situation. He then suggests that you reach out to the client's primary care physician to discuss the possibility of hospitalization and other forms of support that might be available to the client. After further discussion, you call the client's physician and discuss the options. | 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. | What should you first do when the client discloses leaving a suicide note? | Have the mother transport the client to an inpatient facility. | Create a safety plan | Call 911 | Conduct a suicide risk assessment | (A): Have the mother transport the client to an inpatient facility.
(B): Create a safety plan
(C): Call 911
(D): Conduct a suicide risk assessment | Conduct a suicide risk assessment | D | This is the correct answer as this would give you more insight into where the client is in regard to suicide risk. It will also provide you with objective information to substantiate or refute your assertion that the client needs hospitalization. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,425 | Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual | Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin. | Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers. | null | In determining a preliminary diagnosis, the counselor should first consider? | Cultural factors | Subject of the hallucinations | Time of day | Substance use | (A): Cultural factors
(B): Subject of the hallucinations
(C): Time of day
(D): Substance use | Substance use | D | Delusions and hallucinations may be caused by substance use. It is important to first rule out any physical causes such as substance use, brain injury, or other medical conditions. After these are ruled out, it is important to consider cultural factors. In certain cultures, hallucinations and delusions are part of the cultural norm. Time of day and subject of the hallucinations are not relevant for determining a preliminary diagnosis. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,426 | 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. | flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya | All of the following would be appropriate short-term goals for the client following or during a manic episode EXCEPT: | Engage in good sleep hygiene. | Identify and learn to replace thoughts and behaviors that trigger or maintain manic symptoms. | Identify the thoughts and beliefs that support depression. | Improve impulse control. | (A): Engage in good sleep hygiene.
(B): Identify and learn to replace thoughts and behaviors that trigger or maintain manic symptoms.
(C): Identify the thoughts and beliefs that support depression.
(D): Improve impulse control. | Identify the thoughts and beliefs that support depression. | C | The client is still experiencing a manic episode; therefore, focusing on depression is not the main goal because it is not the most prevalent symptom. Focusing on cognitive processing skills and behaviors that trigger or maintain manic symptoms is important in order to work toward decreasing manic symptoms. Sleep hygiene is an important short-term goal because the client is currently not sleeping well and needs support with increasing her sleep. The client needs to work on impulse control because she is engaging in frequent late-night shopping sprees. Therefore, the correct answer is (C) | treatment planning |
1,427 | 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. | e The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination | The DSM-5 defines gender dysphoria as distress stemming from a marked incongruence between one’s assigned gender and which of the following? | One’s reassigned gender | One’s preferred gender | One’s experienced gender | One’s suppressed gender | (A): One’s reassigned gender
(B): One’s preferred gender
(C): One’s experienced gender
(D): One’s suppressed gender | One’s experienced gender | C | The DSM-5 defines gender dysphoria as “a marked incongruence between one’s experienced/expressed gender and assigned gender” The concept of preferred gender implies that one’s gender identity is a choice, which is different than one’s experienced gender. Researchers have found that gender identity can be influenced by prenatal factors, including in utero exposure to or absence of exposure to testosterone (Roselli, 2018). According to DSM-5-TR, gender reassignment “is an official (and usually legal) change of gender” Lastly, gender dysphoria involves incongruence between one’s assigned gender and one’s expressed (rather than suppressed) gender. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,428 | Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency | The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation. | First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his "last chance". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story. She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line "wasn't moving fast enough". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, "It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me." As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve. After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, "It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair." His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, "Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together." The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family. Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook. When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, "Why do you care? You're only asking because you want to get paid." You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, "I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out." After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training. Eighth session The client and his mother arrive for today's session. You begin by meeting with the client alone and plan to speak with his mother afterwards. You ask the client how he has been doing since last week. He is quiet and shrugs his shoulders. You take a moment to notice his non-verbal cues and then gently ask him, "It looks like something is on your mind. Do you want to tell me about it?" He hesitates for a moment and then says, "I don't know. My mom told me that I have to stop playing video games so much. She said it's getting in the way of my homework. But I don't have any friends and video games are the only thing that makes me feel better. It's not fair. My mom gets to do whatever she wants." You listen attentively and validate his feelings. You explain to him that it is important to have a balance between recreational activities and taking care of responsibilities, like doing your homework. You say, "Your mom has a job, right? Sometimes she has to take care of things like going to work or paying bills, and it's the same when we have responsibilities at school. It takes time and effort, but if we do it, then it can free up some time for fun activities like playing video games." He shrugs and says, "Yeah, I guess." You continue the session by discussing his behavior in school and ask him if he can think of any positive experiences he has had since the last session. He thinks for a moment, then starts to shout excitedly, "Yes! There was something!" You intervene by giving him a choice of writing down his feelings or starting over with a quieter tone. He stops, takes two breaths, then proceeds to tell you about his experience in the school playground, where he managed to stay calm when he was provoked by a classmate. He said that his teacher was watching and praised him for staying calm. She gave him a sticker and told him that he could choose the game they would play at recess. You congratulate him on his success and praise him for his efforts. After you conclude the session with him, you invite his mother to your office and direct the client to wait in your waiting room. You talk to his mother to determine how her home parent training is going and review the client's treatment plan with her. His mother states that when she tried to set boundaries on gaming time, he had a "melt down". You suggest that she could consider increasing the amount of time he can play his video games in increments if he meets certain goals, such as completing all of his homework or cleaning up his room. She agrees to try this during the upcoming week. She also mentions that her son continues to struggle socially. When she told him that he could invite a friend over for pizza, he said, "What friend? Making friends is dumb. Who needs them anyway?" Following the session, you receive a phone call from the client's father who states that he has recently reconnected with his family. He says, "My wife told me that you've been working with my son. I know he's got some issues. I'm trying to get back in his life and make things right. What should I do?" | The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a "bully" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a "troublemaker". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. | Following today's session, you attend a staff meeting to discuss the needs of different clients and how best to provide them with quality care. You are asked to provide a clinical opinion regarding your prognosis for this client and rationale for why have you come to that conclusion. What do you say? | Pessimistic due to the severity of the client's past behavior. | Optimistic due to early intervention for the client and the mother's engagement in parent management training. | Optimistic due to the client's early intervention in therapy and engaging in social skill development. | Pessimistic due to the client's refusal to engage in therapy. | (A): Pessimistic due to the severity of the client's past behavior.
(B): Optimistic due to early intervention for the client and the mother's engagement in parent management training.
(C): Optimistic due to the client's early intervention in therapy and engaging in social skill development.
(D): Pessimistic due to the client's refusal to engage in therapy. | Optimistic due to early intervention for the client and the mother's engagement in parent management training. | B | This response reflects the positive developments that have taken place in this client's treatment since early intervention and the mother's active engagement in parent management training. Therefore, the correct answer is (A) | professional practice and ethics |
1,429 | Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual | William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.” | Alcoholism and late-stage medical complications with depression and anxiety
Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist. | Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.” | What information would be most helpful to collect that would support Bob's continued stay in rehab? | protective factors | mental health history | education history | wife's willingness to take him back | (A): protective factors
(B): mental health history
(C): education history
(D): wife's willingness to take him back | protective factors | A | Learning what protective factors Bob has for recovery will be crucial to helping support his continued rehabilitation. Finding close family members, children who might be willing to help him, friends who can reinforce his need for care, defining his spiritual beliefs, or even peer groups or activities he is involved with that can be an asset to understanding Bob and what he values would support your counseling of Bob. Learning his mental health and education history is important but does not necessarily help in maintaining Bob's attendance in rehab, and his wife's willingness to take him back if he leaves rehab early might even motivate him to leave. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,430 | Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3) | Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c | You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder. | age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement | What other information would you need to substantiate the diagnosis of substance use disorder (SUD)? | Strong desire or urge to use the substance | Additional consequences involving law enforcement | Levels of dependence and use for both substances | The effects of acculturation on substance use | (A): Strong desire or urge to use the substance
(B): Additional consequences involving law enforcement
(C): Levels of dependence and use for both substances
(D): The effects of acculturation on substance use | Strong desire or urge to use the substance | A | Craving is described in the DSM-5-TR as a strong desire or urge to use of the substance. Criminal behavior and dependency are no longer criteria for SUD. The effects of acculturation on substance use are important to assess but would not help substantiate the diagnosis of SUD. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,431 | 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. You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief | You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief. Which one of the following accurately depicts this theory? | The stages of grief are often cyclical rather than linear. | Individuals in the first stage of grief may lash out and blame others for their loss. | In the last stage of grief, individuals experience disbelief, shock, and sadness. | All cultures experience grief in the same fashion. | (A): The stages of grief are often cyclical rather than linear.
(B): Individuals in the first stage of grief may lash out and blame others for their loss.
(C): In the last stage of grief, individuals experience disbelief, shock, and sadness.
(D): All cultures experience grief in the same fashion. | The stages of grief are often cyclical rather than linear. | A | Elizabeth Kubler-Ross’s stages of grief are often cyclical rather than linear. While there are defined stages of grief, all individuals experience grief differently, with most moving back and forth between the stages of denial, anger, bargaining, depression, and acceptance. Cultural differences are found in varying practices, rituals, and beliefs that a person incorporates into cultural expressions of grief. Individuals in the second (ie, anger) stage of grief may lash out and blame others for their loss. In the first (ie, denial) stage of grief, individuals experience disbelief and shock, and in the fourth (ie, depression) stage, individuals experience sadness. Therefore, the correct answer is (C) | counseling skills and interventions |
1,432 | Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, "even though there is nothing to be angry about." You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry. | First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels "anger," but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them. The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood. The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them. At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is "guaranteed" a spot. You can accommodate his request and plan to see him again in one week. Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior. Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships. Seventh session The client was a "no show" for his session last week. You did not hear from him and ended up reaching out to him to reschedule. He arrives at this session on time and is eager to talk about a situation that occurred with his daughter. He had reached out to her to talk about repairing the relationship, and after some convincing, she had agreed. She came to pick him up to go for lunch, and while they were in a car together, he used a term that is now considered politically incorrect to refer to one of her friends. His daughter got upset with him and would not speak with him any further. He attempted to defend himself by saying that the term he used was not derogatory. He presents this as "yet another example" of his children not liking him, and "never giving him a chance". He does not know how to move forward. He tells you that he "can't do anything right" and is a failure where his children are concerned. He mentions that this episode was especially frustrating, because he has so happy at arranging this meeting. You disclose your own frustration with one of your family members and explain that sometimes that person only seems interested in connecting with you when they need help. You also incorporate a strengths-based approach to build the client's resilience. | null | Which best describes the therapeutic benefit of using self-disclosure with the client? | To normalize his experience | To facilitate growth | To help minimize the impact of the experience with his daughter | To continue to cement rapport | (A): To normalize his experience
(B): To facilitate growth
(C): To help minimize the impact of the experience with his daughter
(D): To continue to cement rapport | To normalize his experience | A | Self-disclosure can be a means of building rapport with clients, which is essential to the counseling relationship. Counselors often choose to disclose something about themselves and their lives to aid in the development of trust that is necessary for counseling to be effective. Therefore, the correct answer is (A) | counseling skills and interventions |
1,433 | 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 approach considers the implications of the client’s early childhood experiences in the context of the couple’s clinical presentation? | Solution-focused relationship therapy | Person-centered couples therapy | Cognitive-behavioral couples therapy | Emotionally focused couples therapy | (A): Solution-focused relationship therapy
(B): Person-centered couples therapy
(C): Cognitive-behavioral couples therapy
(D): Emotionally focused couples therapy | Emotionally focused couples therapy | D | Created by Sue Johnson, emotionally focused couples therapy considers the influence of early childhood experiences on emotional connection and attachment. The impact of the client’s experiences of neglect likely affects her emotional engagement and feelings of safety and security in the relationship. Counselors using emotionally focused couples therapy help decrease relational distress using steps found in the following three sequential stages: (1) de-escalation, which is used to help the couple see their pattern of negative interactions characterized by self-reinforcing cycles; (2) restructuring interactions—shaping new experiences for couples to connect and form emotional attachments with one another; and (3) consolidation and integration, which is the process used to help clients apply their newly shaped connections to their presenting problems. Person-centered and other humanistic therapies are a part of emotionally focused couples therapy; however, this is not a stand-alone treatment for attachmentCognitive-behavioral couples therapy is a short-term intervention that uses social learning theory and behavioral therapy concepts to help clients cognitively reconstruct beliefs that contribute to relationship distress. Although certain “core beliefs” may be grounded in a partner’s childhood experiences, couples CBT does not exclusively examine attachment. Lastly, solution-focused therapy for couples is a short-term approach used to help assess a couple’s strengths by inquiring about times when there are exceptions to the problem. Solution-focused therapy is not commonly used to examine early childhood experiences or the origins of attachment. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,434 | 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. | During intake, what should you do first? | Complete a more thorough intake interview by completing a biopsychosocial. | Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety. | Document the bullying with input from both the client and his mother in your therapy session notes. | Attempt to develop a therapeutic rapport with the client and mother with empathy. | (A): Complete a more thorough intake interview by completing a biopsychosocial.
(B): Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety.
(C): Document the bullying with input from both the client and his mother in your therapy session notes.
(D): Attempt to develop a therapeutic rapport with the client and mother with empathy. | Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety. | B | To reassure the mother as she has come to you and is in session and protect the client, initiate the Federal and state laws mandate for an investigation procedure that the school will follow, with immediate intervention steps after receiving reports of bullying. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,435 | 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. You conduct a DSM-5-TR Cultural Formulation Interview (CFI) with the client | null | To establish a means for incorporating cultural considerations and clinical symptoms as the sole basis for making an accurate DSM-5-TR clinical diagnosis | To provide culturally specific guidelines to assist with determining the client’s readiness and motivation to change | To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem | To help determine if the client is open to working with a culturally different counselor | (A): To establish a means for incorporating cultural considerations and clinical symptoms as the sole basis for making an accurate DSM-5-TR clinical diagnosis
(B): To provide culturally specific guidelines to assist with determining the client’s readiness and motivation to change
(C): To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem
(D): To help determine if the client is open to working with a culturally different counselor | To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem | C | The benefits of using the DSM-5-TR CFI would be to enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem. The APA developed the CFI as a holistic, person-centered approach to better understand the influence of cultural identity on the client’s clinical presentation and treatment. The CFI is a 16-question interview that covers four domains of assessment: cultural definition of the problem (questions 1–3); cultural perceptions of cause, context, and support (questions 4–10); cultural factors affecting self-coping and past help seeking (questions 11–13); and cultural factors affecting current help seeking (questions 14–16). The CFI is not to be used as the sole basis for determining a diagnosis. Although use of the CFI may help determine the client’s readiness and motivation to change, this is not the primary purpose of the interview. Determining if the client is open to working with a culturally different counselor is not the intended purpose of the CFI. Therefore, the correct answer is (D) | counseling skills and interventions |
1,436 | Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) | Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa | You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills. | The client comes into the session and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results | Which of the following assessments would be the most helpful in identifying possible career options for this client? | Motivational Appraisal of Personal Potential | Work and Social Adjustment Scale | Enneagram personality test | Myers-Briggs Type Indicator | (A): Motivational Appraisal of Personal Potential
(B): Work and Social Adjustment Scale
(C): Enneagram personality test
(D): Myers-Briggs Type Indicator | Motivational Appraisal of Personal Potential | A | The Motivational Appraisal of Personal Potential career assessment identifies career options based on an individual’s interests. The enneagram and the Myers-Briggs Type Indicator are personality tests, and, although they may identify traits about a person that may be helpful in processing options, they do not focus on career options. The Work and Social Adjustment Scale is an assessment that identifies how mental health functioning affects functioning in multiple areas of a client’s life. Therefore, the correct answer is (D) | counseling skills and interventions |
1,437 | 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. | When you tried leading Millie into deep breathing to alleviate anxiety, she refused. Which strategy will work best with Millie? | Mood Diary and Journal Assignments | Motivational Interviewing | Confrontation | Guided Imagery Meditations | (A): Mood Diary and Journal Assignments
(B): Motivational Interviewing
(C): Confrontation
(D): Guided Imagery Meditations | Motivational Interviewing | B | Millie does not present as being willing to follow instructions or take suggestions and is thoroughly occupied by her own interests, making answers b and c undesirable options. Millie also presents as highly irritable and defensive, making answer d an unlikely useful choice. Motivational Interviewing skills, when used correctly, can help Millie identify barriers to her achieving goals, refine areas of resistance to change, and hopefully increase her willingness to change based on her own internal sense of priorities. Therefore, the correct answer is (A) | counseling skills and interventions |
1,438 | Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues. He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg. | You are a counselor in a community agency setting. Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports. | Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done. | Based on the information provided, what intervention would be most helpful for the client to understand how he developed patterns that he finds problematic in his relationships? | Setting and maintaining boundaries | Journaling | Two-chair exercises using client's mother as second chair | Processing the mother and client relationship | (A): Setting and maintaining boundaries
(B): Journaling
(C): Two-chair exercises using client's mother as second chair
(D): Processing the mother and client relationship | Processing the mother and client relationship | D | Processing the mother and client relationship is most helpful for this client. Self-esteem is developed through early interactions with others, especially one's primary caregivers. Many of the client's current behaviors mimic those he used when relating to his mother, whom he described as extremely critical and not meeting his needs or those of others. It will be helpful to have the client process how his own self-esteem developed and how he internalized strategies to protect himself from self-esteem injuries. Journaling is a helpful process for clients who are able to access emotions and insight as they will often use their writings to begin working out their thoughts and feelings outside of session. This client may benefit from journaling as therapy continues but currently uses protective strategies to prevent self-esteem injuries. Setting and maintaining boundaries is a helpful communication and behavioral skill that the client may benefit from later in counseling to help curb some of his narcissistic traits related to jealousy and entitlement. These are not likely to be helpful at this point in therapy. Using the two-chair method to work through mother-client difficulties maybe helpful in therapy later. At this time, it is most important for the client to begin understanding the relationship and its impact on his personality. Therefore, the correct answer is (C) | treatment planning |
1,439 | Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent. | First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that "life has no meaning." She is seeking your help to find some relief. You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery. Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history. Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to "get some fresh air". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her. You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced. Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience. You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally. | The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities. | What is the most effective way for the client to manage her increased levels of fear and distress? | Finding meaning and value in life. | Utilizing calming techniques. | Seeking support from family members and friends. | Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts. | (A): Finding meaning and value in life.
(B): Utilizing calming techniques.
(C): Seeking support from family members and friends.
(D): Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts. | Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts. | D | Self-reflection helps the client gain perspective on the situation and provides a safe space to pause and consider her thoughts before reacting emotionally. Relaxation techniques help to reduce anxiety and can provide a calming effect. Therefore, the correct answer is (B) | counseling skills and interventions |
1,440 | Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual | Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin. | Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers. | null | Based on the Initial Intake, which of the following can be ruled out? | Schizotypal (ability to maintain a relationship) | Brief psychotic disorder | Schizophrenia | Schizoaffective disorder | (A): Schizotypal (ability to maintain a relationship)
(B): Brief psychotic disorder
(C): Schizophrenia
(D): Schizoaffective disorder | Schizotypal (ability to maintain a relationship) | A | The essential feature of schizotypal disorder is "a pervasive pattern of social and interpersonal deficits marked by and acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior". It is not likely that he would meet the criteria for schizotypal disorder as he has been able to maintain a stable relationship. From the information provided, Mark's symptoms can be indicative of brief psychotic disorder, schizophrenia and schizoaffective disorder. To rule out any of these, it would be helpful to know the length of time symptoms have occurred. Brief psychotic disorder has a timeframe of less than one month, where in schizophrenia, the disturbance lasts for more than 6 months. Schizoaffective disorder is characterized by one depressive or manic episode. Therefore, the correct answer is (D) | counseling skills and interventions |
1,441 | Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others. | You are a non-Hispanic counselor in a private practice setting. Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career. | Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works. | Using the information you have learned, which of the following should be the first focus of this session? | Ask the client why receiving the books made her panic. | Have the client describe what it feels like to be stressed and overwhelmed. | Ask how did the client manage her concerns with sending her parents money. | Assess the client's past history of panic attacks. | (A): Ask the client why receiving the books made her panic.
(B): Have the client describe what it feels like to be stressed and overwhelmed.
(C): Ask how did the client manage her concerns with sending her parents money.
(D): Assess the client's past history of panic attacks. | Assess the client's past history of panic attacks. | D | The client has not mentioned panic attacks previously, so the counselor will need to understand the client's history of panic attacks, including any triggers, symptoms, and how the client has managed her attacks in the past. This will help the counselor and client form a treatment plan to manage the client's stress and any future panic attacks. The counselor should not ask about the client's parents and how she managed that issue. Since the client has not brought it up, the counselor may likely be indulging the counselor's own curiosity, rather than asking for therapeutic reasons. Having the client describe how it feels to be stressed and overwhelmed will be addressed in the session as the counselor and client develop treatment strategies for maintaining the client's well-being. Stress and feeling overwhelmed in the moment when embarking on a new venture, such as graduate school, is not abnormal and should not be pathologized. However, because the client states she had a panic attack and has a history of panic attacks, it will be important to address the panic attacks first and then work backwards to feelings of stress. Asking the client why her books triggered a panic attack will not be a helpful question. Panic attacks are triggered by content that may or may not have connection to the actual panic. Asking why the books were a trigger is not important to understanding the panic attack. Therefore, the correct answer is (C) | counseling skills and interventions |
1,442 | 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. | ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s | How would you engage the client during the initial phase of treatment? | Encourage her to keep a thought log to track maladaptive cognitions. | Explore factors she believes maintains her depression. | Tell her about your theoretical orientation and experience. | Determine the expectations she has regarding the length of time in treatment. | (A): Encourage her to keep a thought log to track maladaptive cognitions.
(B): Explore factors she believes maintains her depression.
(C): Tell her about your theoretical orientation and experience.
(D): Determine the expectations she has regarding the length of time in treatment. | Determine the expectations she has regarding the length of time in treatment. | D | The best way to engage the client during the initial phase of counseling is to determine her expectations regarding the length of treatment. Strengthening the therapeutic alliance helps engage clients in therapy. The therapeutic alliance is enhanced when the client and therapist work collaboratively to determine agreed-upon tasks and treatment plan goals. The length of time in treatment is a part of informed consent and is documented on the client’s treatment plan. Telling the client about your theoretical orientation and experience is incorrect because it does not actively engage the client. Counselors adopting a strengths-based approach are more likely to engage and motivate clients. Answers B and D are incorrect because the focus is on the problem rather than the solution. Therefore, the correct answer is (C) | treatment planning |
1,443 | 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. | How do you address the issue of confidentiality with your client when she tells you she does not want any of her co-workers to find out she is in therapy? | You explain that you can only release information to a person who knows her full name and her date of birth, when contacting your office. | You explain that her family may ask you about her care, but you will not confirm or deny she is under your care to anyone else. | You explain the limitations and boundaries of confidentiality and describe the release of information process. | You explain that you cannot release any information under any circumstances to another person while she is in treatment and under your care. | (A): You explain that you can only release information to a person who knows her full name and her date of birth, when contacting your office.
(B): You explain that her family may ask you about her care, but you will not confirm or deny she is under your care to anyone else.
(C): You explain the limitations and boundaries of confidentiality and describe the release of information process.
(D): You explain that you cannot release any information under any circumstances to another person while she is in treatment and under your care. | You explain the limitations and boundaries of confidentiality and describe the release of information process. | C | It is important to educate your clients on how confidentiality works in therapy along with the limits and boundaries. Therefore, the correct answer is (C) | professional practice and ethics |
1,444 | 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. | Considering the level of anxiety the client is demonstrating, which of the following interventions would be appropriate to try? | CBT Thought Record | Solution-Focused | Guided Imagery Meditation | Deep breathing | (A): CBT Thought Record
(B): Solution-Focused
(C): Guided Imagery Meditation
(D): Deep breathing | Deep breathing | D | Modeling and leading a client through deep breathing is an exercise that will most quickly increase a sense of calm, regulate blood pressure, and ground a client's heightened alert state. Guided imagery and meditation can end up increasing a client's symptoms of traumatic stress as survivors may experience flashbacks or heightened emotional arousal. Given that the client is new to you and is distracted, it might prove too stressful for them to attempt working on the other interventions. Counselors need to consider supporting a client using techniques within the timeline and scope of a situation; a decision that is often made on a moment-by-moment basis. Therefore, the correct answer is (D) | counseling skills and interventions |
1,445 | 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 | What are the ethical guidelines for self-referring clients to private practice? | It is prohibited unless your agency makes explicit provisions. | It is prohibited unless provided pro bono. | It is prohibited for five years following the last professional contact. | It is prohibited under all circumstances. | (A): It is prohibited unless your agency makes explicit provisions.
(B): It is prohibited unless provided pro bono.
(C): It is prohibited for five years following the last professional contact.
(D): It is prohibited under all circumstances. | It is prohibited unless your agency makes explicit provisions. | A | The ACA Code of Ethics (2014) states, “Counselors working in an organization (eg, school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services” The 5-year period following the last professional contact refers to the ethical guideline for sexual or romantic relationships with former clients. Pro bono work is encouraged but generally applies to services to the public, such as speaking fees or sharing professional information. Therefore, the correct answer is (C) | professional practice and ethics |
1,446 | 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 | All of the following would provide space for client 4 to participate more, EXCEPT: | Active listening | Rounds | Cutting off | Dyads | (A): Active listening
(B): Rounds
(C): Cutting off
(D): Dyads | Active listening | A | Active listening, although helpful, is not proactive in helping members participate more when they feel like they cannot get space to speak. Dyads and rounds (enlisting a question to the group and then providing every group member the opportunity to answer) provide an individual with an unobstructed opportunity to speak and participate. Cutting off can be helpful in this situation because cutting off members that are dominating conversation and redirecting questions to client 4 can help her feel that she has an opportunity to speak. Therefore, the correct answer is (C) | counseling skills and interventions |
1,447 | Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual | John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.” | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners. | Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment. | Which of the following is the best short-term objective based on SMART goals? | Eliminate explosive outbursts of anger with loved ones within 4 weeks | Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months | Decrease use of alcohol as a means of coping with frustrations and increase healthy habits | Identify underlying triggers associated with anger outbursts | (A): Eliminate explosive outbursts of anger with loved ones within 4 weeks
(B): Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months
(C): Decrease use of alcohol as a means of coping with frustrations and increase healthy habits
(D): Identify underlying triggers associated with anger outbursts | Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months | B | This objective clearly meets SMART goal criteria (specific, measurable, achievable/attainable, relevant/realistic, and time-bound). Answers a) and b) are not specific, measurable or time bound. Although they are good objectives to start with, they just need some refinement to be SMART. Treatment planning objectives that call to eliminate the symptoms of the proposed diagnosed condition within a short amount of time are not realistic. Treatment planning goals in general do not necessarily have to be SMART depending on your organization's priorities, but it is best practice to consider these criteria when preparing your plans for treating your client. Therefore, the correct answer is (D) | treatment planning |
1,448 | Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10) | Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations. | You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.” | The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies. You would like to measure the effectiveness of the group intervention by administering the same standardized instrument that was used previously to measure social performance and anxiety | You would like to measure the effectiveness of the group intervention by administering the same standardized instrument that was used previously to measure social performance and anxiety. This experimental design is an example of which of the following? | One-group pretest-posttest | One-shot case study | One-group posttest comparison | Two-group nonrandom-selection pretest-posttest | (A): One-group pretest-posttest
(B): One-shot case study
(C): One-group posttest comparison
(D): Two-group nonrandom-selection pretest-posttest | One-group pretest-posttest | A | This is an example of a one-group pretest-posttest experimental design. Pretest-posttest experimental designs are conducted using the following steps: (1) a pretest is administered to a group (eg, members participating in group therapy for social anxiety), (2) the intervention (eg, group therapy) is administered, and (3) the same assessment used in the pretest is again administered as a posttest. The purpose of the one-group pretest-posttest design is to determine if the intervention has created a change (ie, did it lessen social anxiety and the related performance avoidance?). This design limits internal validity because of confounding factors, such as history, maturation, instrument decay, and regression toward the mean. It has no external validity. Group posttest comparison does not include a pretest. Group posttests are administered to a group after an intervention. One advantage of group pretests is randomization, which allows the experimenter to control for maturation and history. The “one-shot” case study is a design in which one group is observed on one occasion after the intervention. This design is limited because there is no control group. Two-group nonrandom-selection pre-test-posttest designs consist of an experimental group and a control group. One group is given a pretest, followed by treatment or intervention, and then a posttest is administered. The control group receives a pretest and a posttest only. This design also has limitations related to nonrandomization, such as selection and maturation. Therefore, the correct answer is (A) | treatment planning |
1,449 | Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual | The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene. Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else. | You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help. | Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town. | Based on the information provided, which of the following cultural factors would be most appropriate to explore first with this client? | How the client views her living situation | How the client views her family situation, both past and present | How the client views her widowhood | How the client views her ethnicity | (A): How the client views her living situation
(B): How the client views her family situation, both past and present
(C): How the client views her widowhood
(D): How the client views her ethnicity | How the client views her living situation | A | The priority to explore would be the client's living situation because it is likely to relate to her socioeconomic status. Culture includes a client's race, ethnicity, socioeconomic style, family structure, and any group membership that the client is or becomes a part of that influences her identity and personality formation. The client's family history includes low socioeconomic conditions and government subsidies, which has helped shape the client's views of the world and how she fits in it. Exploring the client's views on her family situation and widowhood may provide other information for understanding the client's cultural formation, but these are not priority given the reason the client has presented for counseling. The client's ethnicity may be explored as a cultural factor if it is found to be a part of the counseling concerns, although given the current information, it does not present as an issue. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,450 | Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center | The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments. | First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee "thunder thighs over there needs to get her act together!" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it "all come crashing down" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment. You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy "since that stuff makes you fat." When you ask her to describe what she eats during a typical day, she says, "I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner." When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, "The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising." As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as "less-than" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image. You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, "I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat." You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food. | The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but "my stepfather is a different story." She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, "I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health." Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels "on edge," and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row. | What short-term goal would be most appropriate to work on during the early stages of therapy? | Find validation and self-worth that is not dependent on physical appearance | Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder | Develop a better relationship with her stepfather built on mutual respect and understanding | Increase body acceptance and develop healthier ways of responding to negative body image thoughts and feelings | (A): Find validation and self-worth that is not dependent on physical appearance
(B): Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder
(C): Develop a better relationship with her stepfather built on mutual respect and understanding
(D): Increase body acceptance and develop healthier ways of responding to negative body image thoughts and feelings | Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder | B | By understanding the origin of her disorder, she can begin to build a foundation of insight that will help support lasting change. With this new awareness, she can also start to cultivate self-compassion and begin to let go of any guilt or shame associated with food or body image issues. Ultimately, this goal will provide her with an understanding and acceptance of herself that she can use as a catalyst for long-term recovery. Therefore, the correct answer is (A) | treatment planning |
1,451 | 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, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client. The client expresses that she is afraid of termination and concerned that she might “fall back into unhealthy eating behavior | The client expresses that she is afraid of termination and concerned that she might “fall back into unhealthy eating behavior.” Which of the following might be most helpful to provide to the client? | express to the client that you are proud of her accomplishments and that she will do great following termination | provide results of weekly screenings to encourage her because she has made significant progress | provide referrals to support groups so the client is connected to others who experience similar symptoms | reassure the client that you are available to restart sessions if she needs support in managing symptoms | (A): express to the client that you are proud of her accomplishments and that she will do great following termination
(B): provide results of weekly screenings to encourage her because she has made significant progress
(C): provide referrals to support groups so the client is connected to others who experience similar symptoms
(D): reassure the client that you are available to restart sessions if she needs support in managing symptoms | provide referrals to support groups so the client is connected to others who experience similar symptoms | C | The client has achieved treatment goals and now social support systems are the most appropriate intervention for maintenance; therefore, support groups would be beneficial by connecting her to others who are experiencing similar struggles. Providing results of screenings does not empower the client to use social support systems, but it may show her that she has been successful and has made progress. You should be careful in showing pride in her success, so that it is clear you are proud of her success, not your own skill as a counselor. It is helpful to let the client know that she should not feel shame in restarting counseling if she needs to, but this does not show her that she has made progress or that you believe that she can manage her emotions on her own. Therefore, the correct answer is (B) | counseling skills and interventions |
1,452 | 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. | 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. | While clenching her fists, the client says, "My teacher hates me. She is always taking everybody else's side and lies to my mom about what happens at school." You respond, "I hear you saying that you're being singled out and that your mom doesn't believe you, and this makes you angry." What are you trying to attempt with this response? | Display and empathic response | Form a therapeutic bond wit the client | Show unconditional positive regard | Demonstrate reflection of the client's feelings | (A): Display and empathic response
(B): Form a therapeutic bond wit the client
(C): Show unconditional positive regard
(D): Demonstrate reflection of the client's feelings | Demonstrate reflection of the client's feelings | D | Reflection of feelings is used in the therapeutic process to accurately describe the client's state from verbal or non-verbal cues. Therefore, the correct answer is (B) | counseling skills and interventions |
1,453 | Refer to the following to answer the next 10 questions: 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. | You have some questions for Millie's father. How should you approach contact? | Ask Millie's permission to speak with her father and then call. | Request that Millie sign a consent for release of information to speak with her father. | It is not advised to speak with her father in this situation. | Call Millie's father and ask him your questions | (A): Ask Millie's permission to speak with her father and then call.
(B): Request that Millie sign a consent for release of information to speak with her father.
(C): It is not advised to speak with her father in this situation.
(D): Call Millie's father and ask him your questions | Request that Millie sign a consent for release of information to speak with her father. | B | HIPAA requires written consent to speak with another person regarding a counselee; even if Millie gave resounding verbal permission, she may revoke this agreement later thus leaving you as the counselor in a legally vulnerable position. Millie is 18 years old and does not fall under the status of Minor; therefore, Millie can deny or revoke consent for you to speak with her parents. Therefore, the correct answer is (C) | professional practice and ethics |
1,454 | Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses | You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment. | The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness | Regarding the client’s thoughts after the second day of using inhalants in a row, which of the following would be the most appropriate cognitive reframe of this thought? | “I may not be able to improve my relationship with my ex-wife or have the visitation agreement that I want. I just need to keep moving forward.” | “I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.” | “I broke my sobriety and need to focus now on how to get back on track.” | “I can contact my lawyer and begin working on the visitation agreement so that I can manage future stress and will be less likely to feel that I need to use inhalants.” | (A): “I may not be able to improve my relationship with my ex-wife or have the visitation agreement that I want. I just need to keep moving forward.”
(B): “I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.”
(C): “I broke my sobriety and need to focus now on how to get back on track.”
(D): “I can contact my lawyer and begin working on the visitation agreement so that I can manage future stress and will be less likely to feel that I need to use inhalants.” | “I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.” | B | Helping the client identify that he is not where he wants to be (in terms of breaking his sobriety) and then identifying that he can start working with his counselor and sponsor to improve his situation is the most helpful reframe to his cognitive distortion. It is most helpful to be realistic with the presenting problem and to choose a path forward. Although the reframe that he may not be able to improve the relationship or visitation agreement might have some truth to it, improving these situations is important for his relationship with his children and for his own mental health; therefore, these are important to continue to focus improvement efforts on. Contacting the lawyer may be helpful for the visitation agreement, but this will not guarantee that the client is going to be okay moving forward. The client needs to improve his behavior and thought processes to maintain sobriety and therefore improve visitations for the long term. Identifying that the client broke sobriety and needs to get back on track is true, but it does not provide the next steps for improving his situation. Therefore, the correct answer is (B) | core counseling attributes |
1,455 | Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School | Appearance: Female with crossed arms, avoiding eye contact, and a blank expression. Affect: Flat affect. Speech: Responses are brief and monotone, lacking emotion. Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation. Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported. Perception: No evidence of hallucinations or delusions. Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills. Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions. | First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that "it wasn't a surprise to get your phone call," as their daughter's behavior is poor at home, too. They are at their "wit's end" due to their daughter's constant "back talking" and "arguing" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts. Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus. Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors. Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor. You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings. Seventh session Today, you meet with Becky and both of her parents. Her father demands to be included in the treatment process. He is adamantly opposed to his daughter being placed in special classes, but the mother expresses her belief that placement in a special class is the best solution. The parents continue to disagree. Finally, Becky screamed out her support for her father's side of the argument. Becky's reaction in support of her father's position only further escalated the disagreement between her parents. Her mother seemed to be taken aback by Becky's outburst and tried to explain calmly why she believed special classes would be the best solution for their daughter. At this point, the conversation became more heated. Her mother expressed her frustration with her husband, saying he always seemed to take Becky's side regardless of the situation. This further agitated the father, and he began to raise his voice in protest. Sensing the tension in the room, Becky suddenly crossed the room and sat on her father's lap. The parents' discussion escalated into an argument, with Becky's mother finally walking out of the office. | The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students. Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. | In which of the following are you demonstrating conflict tolerance appropriately in a therapy session? | Recognize that clients in therapy should express strong feelings and seek to elicit such responses from the client | Recognize that conflict is the problem and, as such, steer the discussion to a more rational framework | Recognize that expressing strong feelings during a session provides a window to the client's underlying issues | Recognize that the participant initiating conflict should seek separate individual therapy to cease being a roadblock to progress. | (A): Recognize that clients in therapy should express strong feelings and seek to elicit such responses from the client
(B): Recognize that conflict is the problem and, as such, steer the discussion to a more rational framework
(C): Recognize that expressing strong feelings during a session provides a window to the client's underlying issues
(D): Recognize that the participant initiating conflict should seek separate individual therapy to cease being a roadblock to progress. | Recognize that expressing strong feelings during a session provides a window to the client's underlying issues | C | Conflict during a session is expected, and a therapist's ability to manage it is key. Therefore, the correct answer is (C) | counseling skills and interventions |
1,456 | Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency | The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore. | First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been "critical of me even talking about moving her into an assisted living facility" and are pressuring her to keep their mother at home. The client starts to cry and covers her face. Finally, she looks up and says, "I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up." The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, "I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen." She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, "It's like history is just repeating itself." She reports feeling "like a failure at being a wife, mother, sister, and daughter." As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it. When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without "losing myself and my sanity in the process." You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy. | The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly "nags" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a "massive strain" on the couple's relationship. | What strength does the client possess that will help her achieve her goals in therapy? | Her deep understanding of Columbian culture and its expectations for elders | Her organizational skills and ability to manage multiple responsibilities at once | Her strong understanding of the needs of her family | Her willingness to engage in self-reflection and be open about her feelings | (A): Her deep understanding of Columbian culture and its expectations for elders
(B): Her organizational skills and ability to manage multiple responsibilities at once
(C): Her strong understanding of the needs of her family
(D): Her willingness to engage in self-reflection and be open about her feelings | Her willingness to engage in self-reflection and be open about her feelings | D | The client's willingness to engage in self-reflection and be open about her feelings is a strength that will contribute to the client's long-term success in counseling. By being honest with herself and willing to discuss her thoughts and feelings, the client has taken an important step towards gaining greater insight into her situation and developing effective coping strategies. Therefore, the correct answer is (C) | treatment planning |
1,457 | Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual | William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.” | Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist. | Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.” | Should you tell your supervisor that Bob has confided in you he will be leaving treatment AMA? | No - sharing the information could harm your therapeutic alliance | Yes - so you can rally your entire team to prevent him from leaving AMA | Yes - confidentiality extends to a "treatment team" in an inpatient setting | No - confidentiality laws prohibit you from telling anyone | (A): No - sharing the information could harm your therapeutic alliance
(B): Yes - so you can rally your entire team to prevent him from leaving AMA
(C): Yes - confidentiality extends to a "treatment team" in an inpatient setting
(D): No - confidentiality laws prohibit you from telling anyone | Yes - confidentiality extends to a "treatment team" in an inpatient setting | C | For your client's safety and to protect company liability it is important to inform your supervisor of Bob's intentions. The treatment team can provide additional support for Bob, whether safety planning support, referral recommendations, family phone calls, and especially medical coordination to ensure Bob has the prescriptions and recommendations needed to proceed mindfully. You should not share this information for the sole purpose of getting others to persuade him to stay, despite the health and relapse risks he is undertaking by leaving AMA. Confidentiality prevents you from sharing his information with any party not included in his treatment; this is where private practice and inpatient care can be different, but you should always check first with your institution's HIPAA policies and client's signed confidentiality paperwork. While the therapeutic alliance is important, in an inpatient setting with high-risk clients, it does not take precedence over safety. Therefore, the correct answer is (C) | professional practice and ethics |
1,458 | 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 would be the least effective in helping the client manage the intense emotions that emerge in trauma treatment? | Teaching and practicing breathing and relaxation exercises | Scheduling shorter sessions to reduce the amount of time the client spends with emotions | Having the client select a word or motion that means "I need to stop" | Teaching and practicing a "container" exercise | (A): Teaching and practicing breathing and relaxation exercises
(B): Scheduling shorter sessions to reduce the amount of time the client spends with emotions
(C): Having the client select a word or motion that means "I need to stop"
(D): Teaching and practicing a "container" exercise | Scheduling shorter sessions to reduce the amount of time the client spends with emotions | B | Working with traumatic content often requires a full session or sometimes a 90-minute session so that the counselor and client will have time to work through traumatic material and then help the client regain emotional equilibrium prior to leaving the session. Shorter sessions would not allow the client and counselor to work with disturbing emotional content and still have time to help the client recover from these before the session is over. Container exercises are helpful techniques that allow the client to place their intense emotions in a real or imagined container that will hold these until the next session. Having the client select a word or hand motion that signals the counselor that they need a break because of intense emotions allows the counselor to help the client ground themselves and take time to recover before proceeding again. Teaching and practicing breathing exercises are helpful tools for clients to use when they are overwhelmed with intense emotions. Concentrating on their breathing and relaxing each part of their body distracts the mind from the emotions and allows the client to feel more in control. Therefore, the correct answer is (C) | treatment planning |
1,459 | Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10) | Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia | You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone. | tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her | Which one of the following specifies the level of severity of depression for this client? | Suicidal ideation | Effects on functioning in multiple settings | Number of criteria met over the minimum criteria for diagnosis | Level of depressed mood reported | (A): Suicidal ideation
(B): Effects on functioning in multiple settings
(C): Number of criteria met over the minimum criteria for diagnosis
(D): Level of depressed mood reported | Number of criteria met over the minimum criteria for diagnosis | C | The number of criteria met that is over the minimum criteria for a diagnosis of depression is how a counselor specifies the severity of the depression as mild, moderate, or severe. This client is diagnosed with moderate depression, which is defined as being in between mild and severe depression (in which mild depression meets an amount of criteria just over the minimum requirements and severe depression meets an amount of criteria significantly over the minimum requirements). Suicidal ideation does denote the severity of the depression, but it does not affect the specifier other than being another criterion that is counted. The level of depressed mood is not measured when considering depression other than the state of being in a depressed mood more often than not. The effect of depression on functioning is an important criterion to consider and is also a criterion for the diagnosis of major depressive disorder. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,460 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual | Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling. | Diagnosis: Adjustment disorder with anxiety (F43.22)
You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions. | Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it. | Taylor asks if anyone in your family has autism. What is the best response? | Offer a warm smile and respond asking "How would it help you to know if I did or not?" | None of these options are appropriate. | Gently point out that personal details about the counselor are not important. | Share about those whom you know with autism to create a therapeutic bond. | (A): Offer a warm smile and respond asking "How would it help you to know if I did or not?"
(B): None of these options are appropriate.
(C): Gently point out that personal details about the counselor are not important.
(D): Share about those whom you know with autism to create a therapeutic bond. | Offer a warm smile and respond asking "How would it help you to know if I did or not?" | A | Clients are often looking to bond with their counselor to share similar experiences or seeking support from their counselor through advice based on personal experience. While neither is necessary to offer valid clinical feedback, understanding why a client wants to know can be more helpful in therapy than building rapport through sharing a commonality. Self-disclosure is always at the discretion of the counselor but answer a maintains the focus on the client's feelings. Answer b alters the professional relationship by switching focus to the counselor, which again is at the counselor's discretion but is not the best response. Pointing out that details about yourself are not important when a client has specifically asked them of you can be invalidating if you are unaware of the client's reasons for asking. Therefore, the correct answer is (A) | counseling skills and interventions |
1,461 | Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate. | First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace. You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior. Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work "only a few times" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care. As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation. | The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed. The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as "friends" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists. | Based on a psychoanalytic perspective, what is the primary factor contributing to the client's alcohol abuse? | Learned behavior from his parents | Trauma and attachment issues | Parent's divorce | An Oedipal neurosis | (A): Learned behavior from his parents
(B): Trauma and attachment issues
(C): Parent's divorce
(D): An Oedipal neurosis | Trauma and attachment issues | B | As a psychoanalytic therapist, you recognize the impact of early childhood experiences in holding future behavior. A potential reason for the client's alcohol abuse from a psychoanalytic standpoint is trauma and attachment issues. His childhood experiences with his enmeshed and alcohol-abusing mother are the most significant factor in his developing an attachment to alcohol as a source of comfort and security. The client's history of trauma and his unresolved issues with his mother can be addressed therapeutically. He needs to develop an understanding that alcohol is not a solution and that the only way to heal from past trauma is through self-awareness and emotional processing. In order to do this, he needs to build more secure attachments with others in order to replace. Therefore, the correct answer is (A) | counseling skills and interventions |
1,462 | Initial Intake: Age: 68 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African-American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself. | You are a counselor in a private practice setting. Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife. The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine. | Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.” | Which of the following would be most effective for the client in helping him work through his guilt and anger? | Having the client schedule in-home caregivers despite his wife's objections | Having the client keep a journal of his emotions and thoughts surrounding them | Having the client investigate daily activities for himself in his community | Having the client attend a caregivers' support group in person or virtually | (A): Having the client schedule in-home caregivers despite his wife's objections
(B): Having the client keep a journal of his emotions and thoughts surrounding them
(C): Having the client investigate daily activities for himself in his community
(D): Having the client attend a caregivers' support group in person or virtually | Having the client attend a caregivers' support group in person or virtually | D | Having the client attend a caregivers' support group, particularly a virtual one that does not add the stress of leaving his wife unattended will be the most effective for the client as he appears to have little support. Being able to share his feelings with others that are in similar situations will allow him to see that his emotions are normal and he is not alone. Having the client investigate daily activities is most likely to increase his feelings of guilt and anger as he has stated he often has to cancel because of his wife's needs. Scheduling in-home caregivers despite his wife's objections will likely cause more guilt and anger if his wife is not cooperative. Having the client keep a journal of his emotions and thoughts can be helpful for some clients, particularly when clients are trying to identify their emotions. In this client's case, he is aware of his guilt and anger and why he experiences these. Journaling may help him express these ideas but will not be as helpful as normalizing his experiences by talking with other caregivers and receiving support. Therefore, the correct answer is (C) | treatment planning |
1,463 | Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility | The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor. | First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been "serious problems" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use "got out of control." Although he has been able to maintain sobriety for two years, he says that his wife is "paranoid" that he is using again and insists on knowing where he is "every minute of the day." He further reports that his wife is "too dependent" on him, and he feels "suffocated." He says, "I just can't keep doing this" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, "Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him." She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, "he just gets mad and leaves the room." Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again. Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, "That's not true!" and proceeds to tell you that she "caught" him holding a bottle of liquor in their garage this morning. The husband replies, "I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?" She replies, "I really want to believe you, but you make it really hard to do that." He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, "Fine. You know where to find me." The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words. You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to "make things right" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship. After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city. | The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father. | What would have been the most effective method for handling the emotional escalation that occurred during this session? | Ask the husband to stay and explain why he was drinking in the morning. | Ask the couple to take a break for a few minutes and then come back together to discuss the situation. | Ask the husband to leave the session and to only attend therapy sober. | Engage in a psychoeducational unit on metacommunicative techniques to give the couple the means to examine their communication style, | (A): Ask the husband to stay and explain why he was drinking in the morning.
(B): Ask the couple to take a break for a few minutes and then come back together to discuss the situation.
(C): Ask the husband to leave the session and to only attend therapy sober.
(D): Engage in a psychoeducational unit on metacommunicative techniques to give the couple the means to examine their communication style, | Ask the couple to take a break for a few minutes and then come back together to discuss the situation. | B | Taking a time out is a healthy way to de-escalate the situation. This allows the couple to take a break, cool down, and then come back together to discuss the situation and work on a solution. Therefore, the correct answer is (D) | counseling skills and interventions |
1,464 | Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency | The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions. | First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding. You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, "I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me." The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply. This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, "I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you." | The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use. | You are a supervised intern in your last few weeks of supervision and assigned to work with a client via Telehealth. The platform you are considering using automatically records the sessions. What should you do first? | Discuss the expectations and goals of Telehealth therapy with the client | Determine if the Telehealth platform is HIPAA compliant | Have your supervisor sit in on the session as you are an intern | Obtain informed consent from the client | (A): Discuss the expectations and goals of Telehealth therapy with the client
(B): Determine if the Telehealth platform is HIPAA compliant
(C): Have your supervisor sit in on the session as you are an intern
(D): Obtain informed consent from the client | Determine if the Telehealth platform is HIPAA compliant | B | Before you start therapy with the client, you must know if the platform is HIPAA compliant, as it is your responsibility to ensure that client data is kept secure. Therapists should use a HIPAA-compliant platform to ensure that their clients' protected health information (PHI) is kept secure and confidential. HIPAA (the Health Insurance Portability and Accountability Act) is a federal law that sets standards for protecting PHI. It requires that any platform used to store, transmit, or receive PHI must have certain safeguards to protect the data's privacy and security. Therefore, the correct answer is (B) | professional practice and ethics |
1,465 | Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, "It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now." The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control. | First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the "doctors are missing something" for years. She "feels sick all the time" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the "lack of care" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation. You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career. Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports "battling anhedonia." It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips. You state to the client, "It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?" The client replies, "Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up." You ask the client, "Have people actually said anything to you about your weight?" She responds, "No, but I can tell they're thinking it." As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment. Tenth session It's been two and a half months since you first started seeing the client for weekly therapy sessions. Today, your client appears calm and relaxed. You review her progress and highlight her areas of growth since the start of therapy. The client states that she feels more empowered to challenge her negative thoughts and is able to recognize when her anxiety is beginning to spiral. She has been using the coping skills she learned in the previous sessions to manage her stress levels more effectively. The client also reports a weight loss of 5 pounds since beginning therapy, which she is pleased with and attributes to the mindfulness techniques she has been practicing. You discuss her weight loss and the importance of mindful eating practices. You explain to the client that weight loss is a secondary outcome of therapy and that it is more important to focus on living a healthy lifestyle than a number on a scale. The client expresses her understanding and appreciation for the guidance. When you ask her to rate her level of anxiety, she indicates that she is much less anxious than when she first started therapy. Her preoccupation with illness has decreased, though it has not gone away completely. She reports that her colleagues have noticed the change in her attitude and confidence. She is able to stay present and focus on her job, without constantly worrying about negative judgement from her co-workers. She tells you that she has been keeping up with the journaling homework that you assigned in a previous session and it has been a helpful outlet for her to express her thoughts. She has also been practicing progressive muscle relaxation during her breaks at work and after she gets home in the evenings. The client is still drinking wine to help her relax, but you have determined that her alcohol use does not warrant clinical intervention. You discuss spacing out your sessions and she agrees to try meeting with you twice a month. At the end of the session, she asks if you could email her a copy of her therapy records so that she can refer back to them periodically in order to continue making progress. | 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. | What additional support service would you recommend to the client at this time? | AA meeting | Social support group of women in the healthcare field | Support group for anxiety | Psychiatric evaluation | (A): AA meeting
(B): Social support group of women in the healthcare field
(C): Support group for anxiety
(D): Psychiatric evaluation | Support group for anxiety | C | A recommendation to attend group therapy will offer ongoing support for your client to address any issues which she may encounter once she has completed therapy with you. She will be able to share her success and also learn how her peers cope with their symptoms. Of course, you can remind your client she may follow up with therapy in the future, as needed. Therefore, the correct answer is (A) | treatment planning |
1,466 | 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. | The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment | Which of the following psychosocial interventions uses tangible memory triggers to prompt discussions of past experiences? | Reality orientation | Reminiscence therapy | Cognitive stimulation therapy | Validation therapy | (A): Reality orientation
(B): Reminiscence therapy
(C): Cognitive stimulation therapy
(D): Validation therapy | Reminiscence therapy | B | Reminiscence therapy uses tangible memory triggers (eg, photographs, music, household items) to prompt discussions of past experiences. Reminiscence therapy, validation therapy, cognitive stimulation therapy, and reality orientation are evidence-based psychosocial interventions for persons experiencing cognitive impairment. Reminiscence therapy improves factors associated with an individual’s quality of life, such as depression and apathy. Validation therapy is based on the premise that individuals with cognitive impairment present with confusion to escape reality and do so to avoid loneliness, isolation, and distress. Validation therapy recognizes, respects, and values each individual’s qualities and feelings rather than focusing on their experiences of confusion. Cognitive stimulation therapy typically consists of a variety of activities, puzzles, and games used to improve one’s memory. Cognitive stimulation therapy may also include elements of reality orientation. Reality orientation works by increasing an individual’s awareness of time, location, and surroundings. This is typically done by placing this information on a dry-erase board in an individual’s home or residence. Therefore, the correct answer is (B) | counseling skills and interventions |
1,467 | Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3) | Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg | You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers. | You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process | When addressing the client’s behavioral response to the denial of a snack, which one of the following would be the most appropriate behavioral intervention? | Maintain boundaries and allow the client time to accept the decision that was made about waiting until the end of the session for the snack. | Support the client in requesting the snack in a more appropriate manner and when he does, you provide the snack. | The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request. | Support the client in calming down, and when he does, if he requests the snack in an appropriate manner, he may have it. | (A): Maintain boundaries and allow the client time to accept the decision that was made about waiting until the end of the session for the snack.
(B): Support the client in requesting the snack in a more appropriate manner and when he does, you provide the snack.
(C): The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request.
(D): Support the client in calming down, and when he does, if he requests the snack in an appropriate manner, he may have it. | The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request. | C | The most appropriate behavioral intervention should address the problem behavior, which, in this case, is the reaction to being denied a snack immediately (and not the manner in which he requested the snack). When the client engages in inappropriate behavior in order to gain access to something (in this case, the snack immediately rather than after the session), you should support him in coping with the decision that was made if clear boundaries are set. If the client had inappropriately requested the snack, then you could support the client in requesting the snack more appropriately and provide the snack when he does. Simply allowing the client to accept the decision that was made by his parents is not enough because you want to empower him to cope with his strong emotions. Therefore, the correct answer is (A) | counseling skills and interventions |
1,468 | Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0) | Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f | You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it. | rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family | According to Abraham Maslow’s hierarchy of needs, which of the following would be the most appropriate area of clinical focus at the start of therapy? | Begin substance use counseling to support the client in abstaining from fentanyl use. | Assist the client with processing his feelings regarding cessation of fentanyl use. | Encourage the client to reach out to his children to develop a support system. | Support the client by providing referrals to local soup kitchens and processing barriers to housing. | (A): Begin substance use counseling to support the client in abstaining from fentanyl use.
(B): Assist the client with processing his feelings regarding cessation of fentanyl use.
(C): Encourage the client to reach out to his children to develop a support system.
(D): Support the client by providing referrals to local soup kitchens and processing barriers to housing. | Support the client by providing referrals to local soup kitchens and processing barriers to housing. | D | Maslow’s hierarchy of needs has five levels that include, in order from bottom to top, physiological, safety, love/belonging, esteem, and, finally, self-actualization. The more basic needs starting with physiological must be met in order for an individual to begin working on the other areas. The client’s housing and food situation are both physiological and safety needs and should be addressed and supported. Although working on cessation from fentanyl use and his feelings regarding stopping its use are important, the client is homeless and does not have resources, so this is the most important. The client’s relationship with his children would be classified under the “love and belonging” level in the hierarchy and would not be the area of initial focus. Therefore, the correct answer is (B) | treatment planning |
1,469 | Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent. | First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that "life has no meaning." She is seeking your help to find some relief. You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery. Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history. | The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities. | What technique would best help the client remember the event? | Dream analysis | Hypnosis | EMDR | Cognitive-Behavioral Therapy | (A): Dream analysis
(B): Hypnosis
(C): EMDR
(D): Cognitive-Behavioral Therapy | Hypnosis | B | Hypnosis will allow the client to recover her lost memory of her friend's shooting. Therefore, the correct answer is (B) | counseling skills and interventions |
1,470 | Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately. | You are a counselor in a private practice setting. Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.” | Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose. | Based on the information provided and your diagnosis, which is the next referral to be made for this client? | Family therapy | Alcoholics Anonymous | A Dialectical Behavioral Therapy group | Narcotics Anonymous | (A): Family therapy
(B): Alcoholics Anonymous
(C): A Dialectical Behavioral Therapy group
(D): Narcotics Anonymous | A Dialectical Behavioral Therapy group | C | Dialectical behavioral therapy (DBT) groups are the most widely prescribed treatment for people diagnosed with BPD. The individual and group therapy focuses on managing emotions and building skills for better relationships. This is the appropriate treatment referral for this client. Either AA or NA can be useful for this client if he demonstrates insight that his substance use is a problem for him, personally or professionally. At this time and given the information provided, the client does not yet demonstrate that understanding so he is unlikely to attend or benefit from substance abuse self-help groups. Family therapy is not likely to be helpful at this time for a client with BPD since relationships are often intense and fluctuating depending on the client's level of emotion and stress. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,471 | Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10) | Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia | You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone. | The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions. You disagree with the client’s evaluation of her situation and want to support her | You disagree with the client’s evaluation of her situation and want to support her. Which of the following would most support the client’s presenting needs? | Empathize with the client’s thoughts and feelings and encourage cognitive reframing. | Validate the client’s feelings and thoughts in order to continue building rapport. | Encourage cognitive reframing in order to guide the client toward your conclusion about her thoughts and beliefs. | Challenge the client’s thoughts and beliefs. | (A): Empathize with the client’s thoughts and feelings and encourage cognitive reframing.
(B): Validate the client’s feelings and thoughts in order to continue building rapport.
(C): Encourage cognitive reframing in order to guide the client toward your conclusion about her thoughts and beliefs.
(D): Challenge the client’s thoughts and beliefs. | Empathize with the client’s thoughts and feelings and encourage cognitive reframing. | A | Providing empathy and encouraging cognitive reframing are helpful because these actions validate the client’s experience, even if you do not think that it is rooted in reality, and it provides an opportunity for her to identify other ways to think about the situation. Simply validating the client’s experience does not provide the client with other options about how to feel or think. Challenging beliefs does not validate the client’s experience and may make the client feel unheard or that you do not think she is being rational. Encouraging reframing on its own may put pressure on the client to feel a certain way. Pairing empathy with cognitive reframing is a more holistic approach to supporting the client. Therefore, the correct answer is (B) | counseling skills and interventions |
1,472 | 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. | The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response. You feel protective of the client and find yourself becoming increasingly angry with the subgroup’s negative behavior | You feel protective of the client and find yourself becoming increasingly angry with the subgroup’s negative behavior. What is the likely source of these feelings? | Underdeveloped leadership skills | Countertransference | Unhealthy group dynamics | Transference | (A): Underdeveloped leadership skills
(B): Countertransference
(C): Unhealthy group dynamics
(D): Transference | Countertransference | B | The likely source of these feelings is countertransference. Countertransference occurs when the therapist emotionally reacts to transference happening among group members. Countertransference can either be subjective (ie, stemming from unresolved past issues) or objective (ie, stemming from the difficult personalities of group members). Transference involves the unconscious transfer of feelings and reactions to another person or experience encountered in the present moment. Transference occurs in individual and group therapy. When transference happens in group therapy, it can happen with the group leader or other group members. The group is not exhibiting unhealthy dynamics because they are in the middle, or storming, stage of group development, characterized by struggles for power and control. Lastly, because countertransference is a normal experience, it is not caused by underdeveloped leadership skills. However, therapists must be attuned to the present-moment experience required for understanding the subgroup’s behavior. Therefore, the correct answer is (A) | professional practice and ethics |
1,473 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1) | Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam | You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions. | The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process. The client believes he is unworthy of love and destined to fail in intimate relationships | The client believes he is unworthy of love and destined to fail in intimate relationships. This is an example of which one of the following? | Confirmation bias | Overgeneralization | Black-and-white thinking | Personalization | (A): Confirmation bias
(B): Overgeneralization
(C): Black-and-white thinking
(D): Personalization | Overgeneralization | B | The client concludes that because he and his girlfriend broke up, he is unworthy of love and is destined to fail romantically; this is an example of overgeneralization, which occurs when broad conclusions are drawn without supporting evidence. Personalization involves a person believing that they are being targeted by someone else’s behavior when it has nothing to do with them. Black-and-white, or polarized, thinking consists of “either/or” statements or beliefs. Confirmation bias is the tendency to seek out and retain information in line with one’s preconceived notions. Therefore, the correct answer is (B) | counseling skills and interventions |
1,474 | Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3) | Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c | You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder. | The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community | Which family systems approach would best help the client’s parents regain control by examining hierarchical positioning, challenge shifting boundaries, assigning tasks, and reframing? | Contextual family therapy | Structural family therapy | Strategic family systems therapy | Multi-generational therapy | (A): Contextual family therapy
(B): Structural family therapy
(C): Strategic family systems therapy
(D): Multi-generational therapy | Structural family therapy | B | Structural family therapy’s primary purpose is to strengthen the boundaries within family systems. One objective of structural family therapy is to help parents regain control by assessing the family structure and assisting families with setting appropriate boundaries. Treatment phases include joining the family, reconceptualizing (diagnosing) the family, and applying restructuring techniques. Restructuring techniques include: assigning tasks, reframing, shifting boundaries (unbalancing), escalating stress, psychoeducation, blocking transactional patterns, and developing implicit conflict. Multigenerational (Bowenian or Extended) family therapy focuses on eight interconnected concepts. Bowenian family concepts include differentiation of self, emotional triangles, sibling positions, society emotional process, multigenerational transmission process, nuclear family emotional system, family projection process, and nuclear family emotional system. Strategic family therapy differs from structural family therapy in that strategic family therapy places much less emphasis on boundaries and instead focuses on patterns of communication and interactions. Some techniques of strategic family therapy include positive connotation (similar to reframing), paradoxical intervention, pretend techniques, and hypothesizing. Contextual family therapy emphasizes ethical elements of each family, including loyalty, trust, and relational principles. Therefore, the correct answer is (C) | counseling skills and interventions |
1,475 | Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs | Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety | You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI). | The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy | To help with the client’s avoidance of anxiety-provoking situations, you gradually and incrementally expose him to fears previously arranged on a fear hierarchy through a process known as which of the following? | Graded exposure | Systematic desensitization | Flooding | Subjective units of distress | (A): Graded exposure
(B): Systematic desensitization
(C): Flooding
(D): Subjective units of distress | Graded exposure | A | Graded exposure is a process that works by incrementally exposing the client to fears previously arranged on a fear hierarchy. Graded exposure is one component of exposure and response prevention (ERP). Graded exposure is used to gradually increase exposure to higher anxiety-provoking situations until the fear naturally subsides without the client performing ritualistic behaviors, such as mirror-checking. Systematic desensitization is a process that combines exposure with relaxation techniques. Flooding involves exposing the client to the highest level of anxiety-provoking stimuli from the beginning, rather than starting with the lower levels and building up. Subjective units of distress (SUD) measure perceived stress. SUDs are generally measured on a 0-100 scale and correspond to the client’s individualized fear hierarchy. Graded exposure involves starting with exposure exercises with the lowest SUD measures first. Therefore, the correct answer is (B) | counseling skills and interventions |
1,476 | 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 | At this point in the session, the counselor should not? | Explain to Theodore that the most sensible place to live is with Nate | Obtain more information about the relationship between Nate and Theodore | Explore other resources for places Theodore can live | Make a diagram of Theodore and those who are a support to him | (A): Explain to Theodore that the most sensible place to live is with Nate
(B): Obtain more information about the relationship between Nate and Theodore
(C): Explore other resources for places Theodore can live
(D): Make a diagram of Theodore and those who are a support to him | Explain to Theodore that the most sensible place to live is with Nate | A | It is not up to the counselor to verbalize his/her opinion about who Theodore should live with. And it would be judgmental to assume that because of Theodore's age he is not able to live on his own. At this point in the session, the counselor should explore other resources that are available for Theodore. It is also important to better understand the relationship dynamics and history between Nate and Theodore. One way to explore resources and to get a better understanding his relationships and support systems is by drawing a diagram of people he knows and his relationships with them. Therefore, the correct answer is (B) | counseling skills and interventions |
1,477 | Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes "doesn't feel like existing" when thinking about her injury. She shares that the thought of not being able to dance ever again is "too much to bear." Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support. | First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork. Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and "snaps" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, "She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care." After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her "life is ruined now" and "I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed." She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents. | The client reports that she is doing "okay" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle. | You notice the client beginning to sob uncontrollably after she describes how her ballet injury is affecting her. What strategy would you use to help the client manage her intense emotional reaction in session? | Engage her in the present moment using the "name the story" technique | Sit with her in silence, allowing her to emote | Utilize the Gestalt technique of "staying with the feeling" | Validate her emotions and engage her in a guided imagery exercise | (A): Engage her in the present moment using the "name the story" technique
(B): Sit with her in silence, allowing her to emote
(C): Utilize the Gestalt technique of "staying with the feeling"
(D): Validate her emotions and engage her in a guided imagery exercise | Validate her emotions and engage her in a guided imagery exercise | D | Validating her emotions can help her feel heard and understood, which can promote trust and rapport between the therapist and client. Engaging her in a guided imagery exercise can help her focus on her breath and body sensations, which can provide a sense of relaxation and grounding during a highly emotional state. This exercise can also help her shift her focus away from her negative thoughts and emotions, allowing her to feel more in control of her feelings and behavior. Therefore, the correct answer is (D) | counseling skills and interventions |
1,478 | 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 were approached by a local community college to speak to a therapy group that is provided for students regarding management of ADHD | You were approached by a local community college to speak to a therapy group that is provided for students regarding management of ADHD. All of the following are American Counseling Association (ACA) considerations for media presentations, EXCEPT: | If you do not have training as an educator, you must decline to meet with the group. | Your statements must be based on accepted counseling literature and practice. | It is made clear to the group that you are not establishing a counseling relationship with them. | Your statements align with the ACA Code of Ethics. | (A): If you do not have training as an educator, you must decline to meet with the group.
(B): Your statements must be based on accepted counseling literature and practice.
(C): It is made clear to the group that you are not establishing a counseling relationship with them.
(D): Your statements align with the ACA Code of Ethics. | If you do not have training as an educator, you must decline to meet with the group. | A | Training as an educator is not a prerequisite to speaking regarding areas that you specialize in as a counselor, even if it is in an educational setting. The ACA Code of Ethics states that you are within your limits as a counselor if you base your lecture on accepted literature and practices, the group knows that you are not establishing a counseling relationship with them, and your statements align with the ACA Code of Ethics. Therefore, the correct answer is (D) | professional practice and ethics |
1,479 | 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." | null | What is the best way to initially approach the client's repeated cancellations? | Express concern for the client's well-being and discuss the importance of regular attendance | Explain the potential consequences of repeatedly canceling sessions | Plan to educate the client about time management strategies during the next session | Begin a discussion about termination | (A): Express concern for the client's well-being and discuss the importance of regular attendance
(B): Explain the potential consequences of repeatedly canceling sessions
(C): Plan to educate the client about time management strategies during the next session
(D): Begin a discussion about termination | Express concern for the client's well-being and discuss the importance of regular attendance | A | This is the best way to approach the client's repeated cancellations because it shows that you are invested in her well-being and want to ensure that she gets the most out of her therapy sessions. Expressing your concern in a non-judgmental manner will help create an open dialogue with the client, allowing her to share any issues she may be facing and work together to come up with a plan that works for both of you. Therefore, the correct answer is (B) | professional practice and ethics |
1,480 | Initial Intake: Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual | Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
| Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.
History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.
The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments. | null | Which of the following situations would possibly hinder the creation of a therapeutic alliance with Carl? | Ask Carl what qualities he likes in a counselor | Sit with Carl in the center of the room, in an L shape | Sit with Carl on one side of a desk and you on the other | Ask Carl about his expectations for counseling | (A): Ask Carl what qualities he likes in a counselor
(B): Sit with Carl in the center of the room, in an L shape
(C): Sit with Carl on one side of a desk and you on the other
(D): Ask Carl about his expectations for counseling | Sit with Carl on one side of a desk and you on the other | C | Body posture and the physical space of the counseling office is important to keep in mind to create an environment conducive to the counseling process. Placing a structure, such as a desk, between a client and counselor can serve as a barrier to openness. Ideally, the counselor and client should be sitting with no objects between them. This can be face to face, or in an L shape. Due to Carl's history of assaulting a counselor, it would be advisable for the counselor to sit near an exit. Other ways to help build a therapeutic alliance would be to ask Carl about his expectations of counseling in order to provide structure and allow for a conversation about informed consent. Also, by asking Carl what he likes in a counselor, the counselor can see what has worked for Carl in the past. Therefore, the correct answer is (A) | counseling skills and interventions |
1,481 | Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed. | First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, "I keep hurting him. One day I love him, and the next day I can't look at him." She pauses and asks, "What if he leaves me? I can't deal with that." She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness. The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others. She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life. The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress. Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, "He. Left. Me." You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce. The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, "I might as well give up. There's no point anymore." You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment. | The client's father died when she was very young. She describes her mother as having a "difficult time raising me and my brother as a single mother." The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern. | Based on the client's reaction in session, how would you prioritize your next step in treatment? | Take steps to have the client involuntarily committed for her safety | Refer to a psychiatrist for medication evaluation | Explore the safety plan and make adjustments where necessary | Use grounding techniques to stablize intense emotions | (A): Take steps to have the client involuntarily committed for her safety
(B): Refer to a psychiatrist for medication evaluation
(C): Explore the safety plan and make adjustments where necessary
(D): Use grounding techniques to stablize intense emotions | Use grounding techniques to stablize intense emotions | D | In this situation, your priority would be to help the client stabilize and manage her intense emotions, providing immediate emotional support and ensuring her safety. You can use grounding techniques and coping strategies to help her regain a sense of calm and control, allowing her to better process her feelings and discuss her concerns. This would create a safe and supportive environment for her to begin addressing the emotional impact of her husband's decision and to explore potential next steps for coping with the situation. Therefore, the correct answer is (C) | treatment planning |
1,482 | 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 reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life. When the client shares recent developments, you find yourself tearing up as you tell him you are happy that he is starting to experience a level of peace in his life | When the client shares recent developments, you find yourself tearing up as you tell him you are happy that he is starting to experience a level of peace in his life. Which core counseling attribute does this represent? | Cultural attunement | Empathetic responding | Metacommunication | Genuineness | (A): Cultural attunement
(B): Empathetic responding
(C): Metacommunication
(D): Genuineness | Genuineness | D | Counselors show genuineness by responding in a manner that is consistent with the client’s and their own internal emotional experiences. Genuineness is about responding authentically, in the present moment, in a way that is verbally and emotionally congruent; ie, there is consistency between the counselor’s words and non-verbal behaviors. Empathetic responding occurs when counselors convey an understanding and non-judgmental acceptance of a client’s expressed and underlying feelings. It consists of perceiving, understanding, experiencing, and responding. Empathetic responding differs from genuineness in that it refers to the counselor’s response to the client’s, not the counselor’s, emotional expression. Metacommunication refers to the counseling process as it is unfolding. It is communication about communication, including verbal or non-verbal cues, that carry depth and meaning. Counselors who show cultural attunement skillfully communicate that they both know and do not know the cultural realities of those we treat. Cultural attunement is about remaining teachable and having the desire, humility, and curiosity to acknowledge things such as privilege and oppression, for example. Therefore, the correct answer is (A) | counseling skills and interventions |
1,483 | 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 | All of the following demonstrate an open counseling stance EXCEPT: | Mirroring | Smiling | Arms are not crossed | Leaning forward | (A): Mirroring
(B): Smiling
(C): Arms are not crossed
(D): Leaning forward | Leaning forward | D | Leaning forward can come across as aggressive or argumentative behavior if not reciprocated or as part of mirroring the client. It is best to sit back in the chair or, if standing, to lean on a wall. Smiling and keeping your arms open show that you are relaxed and not closed off to the client. Mirroring is helpful because it is about matching the emotions of the client and their posture, which shows attunement to the client’s mental state. Therefore, the correct answer is (C) | counseling skills and interventions |
1,484 | 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 | Which one of the following is more indicative of suicidal self-injury than nonsuicidal self-injury (NSSI)? | A desire to cause harm, to feel better, or to end distressing feelings permanently | A persistent urge to cause harm that is often difficult to resist | Difficulty coping with negative emotions and poor self-worth immediately before the injurious act | The constant need to regulate persistent emotional pain and self-critical thoughts | (A): A desire to cause harm, to feel better, or to end distressing feelings permanently
(B): A persistent urge to cause harm that is often difficult to resist
(C): Difficulty coping with negative emotions and poor self-worth immediately before the injurious act
(D): The constant need to regulate persistent emotional pain and self-critical thoughts | A desire to cause harm, to feel better, or to end distressing feelings permanently | A | The desire to cause harm, feel better, or end distressing feelings permanently is more indicative of suicidal self-injury than NSSI. Suicidality differs from NSSI in that there is a desire to permanently end feelings. In contrast, with NSSI, there is a chronic or persistent urge to cause harm to oneself to regulate or detach from distressing emotions. The DSM-5-TR discusses NSSI not as a mental disorder, but as a symptom or consequence that may be confronted when supporting individuals with mental disorders. With NSSI, there is no suicidal intent. Instead, there is the expectation that the self-inflicted damage relieves a negative feeling or cognitive state. NSSI may also include intentional injury associated with feeling distressed, anxious, sad, or tense. Feelings immediately before the act may also be coupled with self-criticism. Finally, NSSI is associated with the persistent urge to cause harm that is often difficult to resist. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,485 | 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 | A few days later, after Harold informs the counselor he no longer wants her as a counselor, Harold came to the counselor's office with a small, wrapped box. Harold stated that it was just a small token to say thank you. Under ethics rules, the counselor should? | Thank Harold and wish him the best, opening the gift later. | Tell Harold she needs to speak to her supervisor first and then will get back to him | Thank Harold but tell him that she cannot accept any gifts | Open the box in front of Harold and give it back to him if it seems expensive | (A): Thank Harold and wish him the best, opening the gift later.
(B): Tell Harold she needs to speak to her supervisor first and then will get back to him
(C): Thank Harold but tell him that she cannot accept any gifts
(D): Open the box in front of Harold and give it back to him if it seems expensive | Thank Harold and wish him the best, opening the gift later. | A | In most cases, a is the best choice since Harold is no longer a client. Counselors should be aware of the code of ethics which state that "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 take gift from a client, counselors consider 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". In this scenario, the client and counselor have terminated their relationship and the gift is a token to say thank you. By telling Harold she cannot take any gifts, Harold may be offended. This may cause undo harm, which goes against ethical standards. Opening the gift in front of him and then possibly giving it back can be uncomfortable for both parties. Choice d leaves the situation in a limbo and the counselor should be aware of the code of ethics when presented with a gift. Therefore, the correct answer is (A) | counseling skills and interventions |
1,486 | Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice | The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, "It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now." The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control. | First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the "doctors are missing something" for years. She "feels sick all the time" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the "lack of care" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation. You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career. Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports "battling anhedonia." It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips. You state to the client, "It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?" The client replies, "Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up." You ask the client, "Have people actually said anything to you about your weight?" She responds, "No, but I can tell they're thinking it." As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment. | The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life. She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a "charge nurse." She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition "because those issues run in my family." There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. | Using a cognitive-behavioral approach, how would you help your client practice decentering from her thoughts? | "We can't control what other people think about us, but we can control how we think about ourselves." | "I'd like for you to try to have a dialogue with the part of you that feels judged and 'not good enough.' What would you say to that part of yourself?" | "When you start to feel like you're being judged and aren't good enough, try to replace those negative thoughts with a positive affirmation." | "Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth." | (A): "We can't control what other people think about us, but we can control how we think about ourselves."
(B): "I'd like for you to try to have a dialogue with the part of you that feels judged and 'not good enough.' What would you say to that part of yourself?"
(C): "When you start to feel like you're being judged and aren't good enough, try to replace those negative thoughts with a positive affirmation."
(D): "Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth." | "Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth." | D | Decentering can help people step back and observe their thoughts, feelings, and bodily sensations from a distance. It encourages people to observe experiences as if they are happening to someone else, rather than taking them on directly. This helps reduce the intensity of these experiences and create some psychological distance between them and their thoughts. Decentering can help people gain insight into how their beliefs and opinions influence their feelings, and can help them better manage their emotions. It also encourages self-compassion by allowing people to be kind and understanding towards themselves in difficult situations. Therefore, the correct answer is (A) | counseling skills and interventions |
1,487 | 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. | What is the best response for how to guide this parent while building the therapeutic alliance? | "Don't worry, you're doing a great job and he will grow out of this phase eventually." | "I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together." | "Use negative reinforcement to deter his behavior and CBT for addressing negative patterns." | "You have to implement stronger boundaries in order for my interventions to be effective." | (A): "Don't worry, you're doing a great job and he will grow out of this phase eventually."
(B): "I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together."
(C): "Use negative reinforcement to deter his behavior and CBT for addressing negative patterns."
(D): "You have to implement stronger boundaries in order for my interventions to be effective." | "I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together." | B | Parent behavior management training is an evidence-based treatment teaching parents how to manage difficult childhood behaviors (defiance, outbursts, noncompliance). Validating and encouraging a parent like in answer a) is positive, a positive attitude to have however dismissing the behavior or the parent's role in reinforcing the behavior is not clinically best practice when you are responsible for treating the child conducting those behaviors. Answer b) is an aggressive response to a parent who is actively seeking advice and support, however the need for stricter boundaries may be something the parent should consider. Negative reinforcement and CBT (cognitive behavioral therapy) techniques are also appropriate to teach the parent, but this response assumes the parent understands these terms. It is also best practice to collaborate with the parent on what interventions they have already tried already, and work towards empowering them to select their own options as this approach tends to be the most effective. Therefore, the correct answer is (D) | counseling skills and interventions |
1,488 | 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. | 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. | You tell the client, "What we talk about stays between you and me. You can trust me, but I may have to talk to your mom if you are in danger or others are in danger. Do you understand what I am saying?" What are you doing here? | Appealing to the client's desire for community. | Forming rapport and trust | Explaining confidentiality in terms he can understand | Assessing for homicidal ideation | (A): Appealing to the client's desire for community.
(B): Forming rapport and trust
(C): Explaining confidentiality in terms he can understand
(D): Assessing for homicidal ideation | Explaining confidentiality in terms he can understand | C | This is the correct answer because the client is 11 years old. Using terms he can relate to will make it easier for him to comprehend. Therefore, the correct answer is (D) | professional practice and ethics |
1,489 | 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's expression of emotion is a relief to you. How do you tell her this? | "If you had shared sooner, you could be farther along in the healing process." | "Your expression of emotion means you are finally facing your reality." | "I am proud of you for being brave by admitting all of this, you are amazing!" | "So frustrating! I am so grateful you can share this with me. I'm here for you." | (A): "If you had shared sooner, you could be farther along in the healing process."
(B): "Your expression of emotion means you are finally facing your reality."
(C): "I am proud of you for being brave by admitting all of this, you are amazing!"
(D): "So frustrating! I am so grateful you can share this with me. I'm here for you." | "So frustrating! I am so grateful you can share this with me. I'm here for you." | D | This is the most empathic answer without causing shame as in answer a), reversing the focus to your own reaction and opinion of her like in answer b), or pointing out her process for her like in answer c). Therefore, the correct answer is (D) | counseling skills and interventions |
1,490 | 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. | You have attempted to arrange a family session with the mother, but she is unable to take off work to attend. The client arrives for his second session eager to share that he is “on green” this morning, which means the client’s behavior for the day has been good. You praise him for staying in his seat and keeping his hands and feet to himself. The client responds well to your praise. When engaging in a feelings identification activity, the client identifies feeling unhappy and worried when his father doesn’t show up for scheduled visitation. The client explains that his parents frequently argue about “how to take care of me” and “sometimes push each other.” He quickly abandons the feelings activity and asks if he can go back to class. You deny the client’s request to leave and instead give him the option of selecting another activity. The client refuses to do so and begins to kick your file cabinet repeatedly. He proceeds to knock papers off your desk. When redirected, the client’s behavior escalates. He quickly becomes inconsolable as he cries and yells, “I hate counseling, this school, and everyone in it!” During the feelings identification activity, you respond to your client’s disclosure by stating, “You’re feeling sad and miss your dad. And on top of worrying about him, it sounds like you feel responsible for some of your parents’ grown-up problems | During the feelings identification activity, you respond to your client’s disclosure by stating, “You’re feeling sad and miss your dad. And on top of worrying about him, it sounds like you feel responsible for some of your parents’ grown-up problems. Am I getting this right?” This is an example of a(n): | Additive encourager | Advanced paraphrase | Clarification | Complex reflection | (A): Additive encourager
(B): Advanced paraphrase
(C): Clarification
(D): Complex reflection | Complex reflection | D | Complex reflections go beyond simple reflections and paraphrasing by addressing the client’s underlying or implicit thoughts, feelings, and experiences. In this response, you validate the client’s feelings (sad and worried), allude to additional feelings of being overwhelmed (and on top of worrying), and attempt to counter any personal responsibility for “grown-up problems” Since the client is still in the early stages of therapy, it is often helpful to ask if your interpretation is correct. (“Am I getting this right?”) This response helps subtly shift the power dynamic from that of an authoritative adult to one who understands the child and the world around them. An encourager or lead is a prompt used to help the client continue expressing themselves. Encouragers can be both verbal (“Please, go on”) or non-verbal (head nodding) and are used to convey interest in what the client is expressing. Additive empathy is a core counseling attribute (rather than an additive encourager). Clarification is used when the client’s statement is vague or confusing. (Client: “I’m just done” Therapist: “Can you tell me what it means for you to be done?”) Paraphrasing selectively focuses on the client’s intended message or meaning. Paraphrases are different from reflections in that paraphrases solely concentrate on the content of the client’s statement. Paraphrases do not involve reflecting the client’s feelings. Therefore, the correct answer is (A) | counseling skills and interventions |
1,491 | 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. | History of Condition: The client’s milestones were all developmentally appropriate; he was walking at ten months, toilet trained by 24 months, and speaking in complete sentences at almost 30 months. The mother describes the client as “moody” beginning in kindergarten. His temper outbursts began to escalate in intensity and duration within the last few years. During this time, there were no known associated stressors. The mother reports that the client has always had a hard time following directions and difficulty complying with authority figures. Family History: The client has two maternal half-brothers, ages 18 and 20, and has positive relationships with both of them. His parents divorced when the client was three years old, and the mother has physical custody of the child\. Before the divorce, the client witnessed verbal and physical altercations between his parents. The client’s father visits periodically, and he has been in and out of substance abuse treatment centers for most of the client’s life. When angry with his mother, the client tells her he wishes he could live with his father. The client’s maternal grandmother is diagnosed with bipolar disorder, and the client’s mother states she struggles “off and on” with depression. Aside from the father’s substance use disorder, a paternal history of mental illness is unknown | In addition to severe temper outbursts, which information is most indicative of the diagnosis of Disruptive Mood Dysregulation Disorder (DMDD)? | Defiance towards authority | Social-emotional difficulties | Irritability | Impulsivity | (A): Defiance towards authority
(B): Social-emotional difficulties
(C): Irritability
(D): Impulsivity | Irritability | C | Disruptive Mood Dysregulation Disorder (DMDD) is characterized by severe and recurrent temper outbursts (at least three times per week) and irritability. According to the DSM-5-TR, irritability must be chronic and persistent (nearly every day, most of the day). Defiance to authority, a characteristic of Oppositional Defiant Disorder, is not a manifestation of DMDD. Socio-emotional difficulties characterize Autism Spectrum Disorder, and impulsivity is a symptom of ADHD, making both answer options incorrect. Further, if a client meets the criteria for both DMDD and ODD, they should be assigned the diagnosis of DMDD. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,492 | Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22) | Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor | You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable. | The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her. You administer the Self-Directed Search (SDS) career assessment tool to determine the client’s three-point Holland code | You administer the Self-Directed Search (SDS) career assessment tool to determine the client’s three-point Holland code. If the client’s code is SAE, which occupation would give her the highest job satisfaction? | Systems analyst | Veterinarian | Interior decorator | Accountant | (A): Systems analyst
(B): Veterinarian
(C): Interior decorator
(D): Accountant | Interior decorator | C | An interior decorator would give the client the highest job satisfaction of the careers listed if her code is SAE (social, artistic, enterprising). John Holland conceptualized six occupational and personality categories: realistic (R), investigative (I), artistic (A), social (S), enterprising (E), and conventional (C), or RIASEC. Holland used a hexagon to illustrate the positioning of each occupational category, with each point representing one of the Holland types. Work environments and personalities that are most similar are adjacent to one another. For example, the client is a teacher, which puts her in the social category. The social category includes career environments and personality types described as humanistic and responsible (eg, teachers, nurses, social workers). Categories adjacent to social (ie, artistic and enterprising) are more likely to include careers that would also be a good fit for the client. For example, interior design is grouped with the artistic category. Accountants are included in the conventional category, which is nonadjacent to social. Another nonadjacent category is the realistic category, which includes careers such as veterinarian. Lastly, systems analyst is included in the investigative category, which is also nonadjacent to the social category. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,493 | 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. | Third Session, 3 Weeks After the Initial Intake 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. You are using narrative therapy with the couple | You are using narrative therapy with the couple. Which one of the following actions is an example of narrative therapy? | In a therapy session, each individual tells the story of their relationship from the view of a narrator in order to see things more objectively. | Prompt the couple to read therapeutic books related to their problem areas. | Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective. | Provide homework for the couple to write a story together in order to work on collaborating and considering each other’s viewpoints. | (A): In a therapy session, each individual tells the story of their relationship from the view of a narrator in order to see things more objectively.
(B): Prompt the couple to read therapeutic books related to their problem areas.
(C): Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective.
(D): Provide homework for the couple to write a story together in order to work on collaborating and considering each other’s viewpoints. | Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective. | C | Narrative couples therapy involves having each individual write a narrative of their own story and then guiding them to rewrite the story from a new, more positive, perspective. This process assists the couple with externalizing the problem and also with understanding that there are two sides to a conflict, which helps individuals take responsibility for their own part. By then rewriting the story, the couple is given the opportunity to rework how they will reflect on their past as they move into the future, ideally seeing their relationship more positively. Reading specific therapeutic books related to the problem areas would fall under bibliotherapy. Writing a story together and telling their story as a narrator are not defined clinical interventions specific to narrative therapy. Therefore, the correct answer is (C) | counseling skills and interventions |
1,494 | 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. | 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." | You are considering transferring your client to a colleague. What information would be the most important to include in a discharge summary? | Recommendations for stabilization with sobriety and medication management | Recommendations for enhanced self-care and better coping skills | Recommendations for marital and vocational counseling | Recommendations to develop more effective emotional regulation. | (A): Recommendations for stabilization with sobriety and medication management
(B): Recommendations for enhanced self-care and better coping skills
(C): Recommendations for marital and vocational counseling
(D): Recommendations to develop more effective emotional regulation. | Recommendations for stabilization with sobriety and medication management | A | Facilitating the client's stabilization initially will be critical to providing an opportunity for success with treatment. Getting the client involved in motivational interviewing and some form of recovery will be essential while at the same time proper medication management appropriate for the bipolar condition is vital. Therefore, the correct answer is (B) | treatment planning |
1,495 | Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice | The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent. | First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that "life has no meaning." She is seeking your help to find some relief. You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery. Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history. Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to "get some fresh air". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her. You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced. Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience. You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally. | The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities. | What is the best way to address the client's self-reported fear and negative statements about Irish Americans? | Address the client’s prejudice and challenge her new assumptions about this population | Terminate the client due to her prejudiced tendencies and your inability to control her constant use of derogatory slurs | Allow the client to continue expressing derogatory slurs, as this has not been identified as an issue in the treatment plan | Use therapeutic silence to allow the client to recognize your unacceptance of her derogatory slurs | (A): Address the client’s prejudice and challenge her new assumptions about this population
(B): Terminate the client due to her prejudiced tendencies and your inability to control her constant use of derogatory slurs
(C): Allow the client to continue expressing derogatory slurs, as this has not been identified as an issue in the treatment plan
(D): Use therapeutic silence to allow the client to recognize your unacceptance of her derogatory slurs | Address the client’s prejudice and challenge her new assumptions about this population | A | You need to address these issues directly and challenge the client’s worldviews in relation to her anxieties and fears. Therefore, the correct answer is (B) | counseling skills and interventions |
1,496 | Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3) | Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c | You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder. | age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement | What is the primary ethical risk of allowing the client to interpret for his family? | It might cause the client to experience secondary trauma when discussing his parent’s torture. | It might violate the principles of self-determination and autonomy inherent in informed consent. | It might reinforce unhealthy boundaries and contribute to parental inadequacy. | There is the potential for misdiagnosis if the client chooses to interpret selectively. | (A): It might cause the client to experience secondary trauma when discussing his parent’s torture.
(B): It might violate the principles of self-determination and autonomy inherent in informed consent.
(C): It might reinforce unhealthy boundaries and contribute to parental inadequacy.
(D): There is the potential for misdiagnosis if the client chooses to interpret selectively. | It might violate the principles of self-determination and autonomy inherent in informed consent. | B | The primary risk for allowing the client to interpret for his family is that it calls into question the validity of informed consent. The principles of self-determination and autonomy govern informed consent. While the adolescent is the identified client, he does not have the legal right to provide consent for treatment. According to the ACA Code of Ethics (2014), “Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. […] Counselors communicate information in ways that are both developmentally and culturally appropriate. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (eg, arranging for a qualified interpreter or translator) to ensure comprehension by clients” If counselors do not have immediate access to interpreters, remote options are available via phone or video. In certain instances, in some states, using nonprofessional interpreters is against the law. Experiencing secondary trauma is unlikely because there is an increased probability that the client is already aware of the torture or that the parents do not discuss it with anyone. Additional considerations include perpetuating the client’s role as chief decision-maker, selective messaging, and intentional or unintentional miscommunication; however, these issues do not supersede the need to adhere to the principles of self-determination and autonomy. Therefore, the correct answer is (D) | professional practice and ethics |
1,497 | 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. Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs. She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them. As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was "roughhousing" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling. | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal. The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. | You, as a therapist, mention to your spouse that you have a client from Latin America suffering from Panic Attacks. Your spouse tells you that she has a cousin from Latin America with the same problem. When your spouse mentions the cousin's name, you realize this is your client. Have you violated confidentiality, and how should you proceed? | You have not violated confidentiality, and you must explain the situation to your client and ask if she wants to continue therapy. | You have violated confidentiality, and you need to refer the client to another therapist. | You have violated confidentiality, and you need to continue seeing the client. | You have not violated confidentiality, and you need to refer the client to another therapist. | (A): You have not violated confidentiality, and you must explain the situation to your client and ask if she wants to continue therapy.
(B): You have violated confidentiality, and you need to refer the client to another therapist.
(C): You have violated confidentiality, and you need to continue seeing the client.
(D): You have not violated confidentiality, and you need to refer the client to another therapist. | You have not violated confidentiality, and you need to refer the client to another therapist. | D | Since you did not reveal the client's name, you have not broken confidentiality. You should, however, not continue therapy with your client, given that the client is your significant other's relative. It would be a conflict of interest and could potentially damage the trust between you and your client. It is best to refer the client to a different therapist to ensure the best possible care and to maintain the integrity of the therapeutic relationship. Therefore, the correct answer is (C) | professional practice and ethics |
1,498 | Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses | You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment. | The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness | All of the following are possible symptoms of inhalant use, EXCEPT: | Euphoria | Insomnia | Muscle weakness | Nystagmus | (A): Euphoria
(B): Insomnia
(C): Muscle weakness
(D): Nystagmus | Insomnia | B | Insomnia is not typically associated with inhalants. Rather, inhalants generally slow down the body’s movement, slow reflexes, and cause a stupor, likely leading to sleepiness. Nystagmus (uncontrollable eye movement), euphoria (feelings of great happiness or excitement), and muscle weakness are common symptoms of inhalant intoxication. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,499 | Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1) | Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par | You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby. | ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report | When the client leaves the room, which of the following is the most important to consider for an effective counseling intervention with your client? | Encouraging the client to return to the office with the foster parents | The manner in which you enter the lobby and approach the client | Discussing the need for safety and refraining from hitting | Confidentiality when leaving the foster parents in your office | (A): Encouraging the client to return to the office with the foster parents
(B): The manner in which you enter the lobby and approach the client
(C): Discussing the need for safety and refraining from hitting
(D): Confidentiality when leaving the foster parents in your office | The manner in which you enter the lobby and approach the client | B | When considering effective counseling interventions for this client, you must first identify the underlying purpose of the behavior that must be addressed. In this case, while hitting is not an appropriate behavior, it was the client’s method of communicating a feeling of insecurity. Effective counseling to address the feeling of insecurity must start with creating an environment that is comfortable and secure for the client, which is first communicated through the manner in which you enter the lobby and approach the client. Doing so calmly and without judgment will ensure that you are not there to reprimand, but to support. Only if the client feels secure, would discussing the need for safety and refraining from hitting be received and the possibility of the client returning to the office with her foster parents be realistic. Confidentiality when leaving the office is important (and can be enforced by locking your computer and/or taking your notebook so that neither are available to the parents), but this does not directly address an effective counseling intervention with the client. Therefore, the correct answer is (B) | counseling skills and interventions |
1,500 | Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues. He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg. | You are a counselor in a community agency setting. Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports. | Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done. | Using the provided information, which of the following would not be useful to understand the client's current presentation? | Beck's Anxiety Inventory-II (BAI-II) | Family Genogram | Minnesota-Multiphasic Personality Inventory-2 (MMPI-2) | Connors Behavioral Rating Scale (CBRS) | (A): Beck's Anxiety Inventory-II (BAI-II)
(B): Family Genogram
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Connors Behavioral Rating Scale (CBRS) | Connors Behavioral Rating Scale (CBRS) | D | The CBRS is a widely-used assessment for ADHD in children and adolescents. Due to the client's age, this would not be an assessment to use. Because he takes Concerta, the counselor may choose to use an inventory developed for adults. The MMPI-2 is used to assess personality traits and psychopathology. This may help the counselor determine a client's psychological state or a diagnosis, and in this client's case, may help explain some of the patterns that the client exhibits that are not easily fit into a diagnostic category, such as his forgetting, tuning out, and being seen as thinking he is better than others when he does not believe this. Completing and evaluating a family genogram will help the counselor and client identify patterns and interactional dynamics that have become unhealthy ways of thinking and behaving that may have served the client well in childhood with his family of origin but have become problematic in his adult life in his family and other relationships. The BAI-II measures the client's current level of anxiety. The client presents with an anxious mood and takes Pristiq, which is both an antidepressant, and an anti-anxiety medication that works on neurotransmitters that impact the fight-or-flight response. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
Subsets and Splits