Question #
int64 1
1.62k
| Patient Demographic
stringclasses 144
values | Mental Status Exam
stringclasses 139
values | Presenting Problem
stringclasses 229
values | Other Contexts
stringlengths 124
3.29k
⌀ | Question
stringlengths 24
595
⌀ | Choice A
stringlengths 2
294
| Choice B
stringlengths 2
321
| Choice C
stringlengths 1
284
| Choice D
stringlengths 3
414
| Potential Answers
stringlengths 34
1.12k
| Correct Answer
stringlengths 3
284
| Correct Answer (Letter)
stringclasses 4
values | Explanation For Correct Answer
stringlengths 77
2.25k
⌀ | Competency
stringclasses 6
values |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1,601 | Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23) | Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner | You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again. | vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week | Which of the following would be considered a differential diagnosis for adjustment disorder? | Disinhibited social engagement disorder | Normal stress response | Bereavement | Generalized anxiety disorder | (A): Disinhibited social engagement disorder
(B): Normal stress response
(C): Bereavement
(D): Generalized anxiety disorder | Normal stress response | B | When bad things happen, it is normal that it affects the individual. A normal stress response is expected for situations that are difficult, but what distinguishes it as an adjustment disorder is when the stress affects functioning. Generalized anxiety disorder would involve anxiety surrounding general situations that affect functioning, but this would not be appropriate because the anxiety is surrounding his relationship with his wife and children. Although the client is experiencing the loss of a relationship, bereavement is not a consideration because the client is experiencing anxiety and depression surrounding the adjustment to a different way of life as opposed to just about the loss of a relationship. Disinhibited social engagement disorder is when children approach and engage with individuals with whom they are not familiar, but this does not define this individual’s situation. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
1,602 | Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0) | Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th | You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species. | The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.” In part, attitudes stemming from ableism prevent many young adults with ASD from receiving adequate education on intimacy and sexuality | In part, attitudes stemming from ableism prevent many young adults with ASD from receiving adequate education on intimacy and sexuality. Which statement best describes ableism? | Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from an unwillingness to acknowledge and address deficits among individuals suffering with ASD. | Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy. | Ableism is he intentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy. | Ableism is the intentional discrimination and marginalization of individuals with ASD supported by prejudicial actions that they are less capable and worthy. | (A): Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from an unwillingness to acknowledge and address deficits among individuals suffering with ASD.
(B): Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.
(C): Ableism is he intentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.
(D): Ableism is the intentional discrimination and marginalization of individuals with ASD supported by prejudicial actions that they are less capable and worthy. | Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy. | B | Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy. Ableism is rooted in biases that can be either explicit (ie, conscious or intentional) or implicit (ie, unintentional or unconscious). Ableism grants privilege and favor to individuals who are healthy or non-disabled. Answers A and B refer solely to intentional discrimination, making those options incorrect. Answer D includes intentional and unintentional discrimination but is incorrect because it refers to an unwillingness to acknowledge and address deficits among individuals suffering from ASD. The medical model perpetuates stereotypes and biases by referring to individuals with ASD (and other disabilities) as having deficits (akin to being sick) that need an intervention to be cured from the suffering. Neurodiverse advocates maintain that barriers hinder those with ASD from reaching their full potential, and promote an integrative approach by valuing impairment as an integral part of diversity. In terms of sex education and ASD, ableism can lead to perceptions of individuals with ASD as asexual and childlike, leading to the overprotection of individuals expressing normal drives and interests. As a result, sexually active young adults with ASD encounter victimization, unwanted pregnancies, and sexually transmitted infections at higher rates than neurotypical individuals. Further, the ACA Code of Ethics (2014) calls for the promotion of social justice defined as, “treating individuals equitably and fostering fairness and equality”. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
1,603 | 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 is anxiously shaking her leg. Why should you point out this observation to her? | To increase her self-awareness and hope she shares her feelings. | Anxious behaviors further increase anxiety. | To demonstrate her need for counseling. | It is distracting you from things she is saying. | (A): To increase her self-awareness and hope she shares her feelings.
(B): Anxious behaviors further increase anxiety.
(C): To demonstrate her need for counseling.
(D): It is distracting you from things she is saying. | To increase her self-awareness and hope she shares her feelings. | A | Making observations of physical behaviors in session can either help a client share more because they feel seen and validated or cause a client to become more self-conscious and withdraw. It is an empathic technique, much like the active listening skill of reflection, only because it is non-verbal it draws a different reaction. Telling Maria, "I noticed as you discuss your brother's fears, your leg begins to shake," is an open invitation for Maria to share if or why she thinks they are connected phenomena. This can lead to a CBT discussion about how thoughts and feelings affect our behaviors. Anxious behaviors, such as leg shaking, do tend to increase anxiety; however, your goal is not to get her to stop shaking. She may need this subconscious, compulsory action to release tension as she speaks. Regarding answers b) and d), you would not use these observations to prove the point that Maria needs counseling, or to make your counseling experience less distracting. Therefore, the correct answer is (C) | counseling skills and interventions |
1,604 | Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency | Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age. Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport. Speech: Speech volume is normal, and speech flow is normal and spontaneous. Mood: The client's mood is dysphoric and anxious. Thought Process: Thought process is logical. Thoughts are negative. Affect: The client's affect is broad and appropriate to the discussion. Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment. Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average. | First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting. At the end of the session, the client turns to her husband and says, "I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him." Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner. | Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is "on the rocks.'" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, "I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do." | Which of the following behaviors best describes the communication style displayed by the couple in the above session? | Defensive communication style, as described by Gottman's four horsemen theory. | Stonewalling communication style | Contemptuous communication style | Repair communication style | (A): Defensive communication style, as described by Gottman's four horsemen theory.
(B): Stonewalling communication style
(C): Contemptuous communication style
(D): Repair communication style | Contemptuous communication style | C | Contemptuous communication as described by Gottman's four horsemen theory is characterized by sarcasm, eye-rolling, name-calling, and hostile humor. The wife's statement that she has been talking to her ex-partner because he listens to her and makes her feel better can be seen as an expression of contempt towards her current partner. This style of communication is highly correlated with relationship dissatisfaction and breakdown. Therefore, the correct answer is (A) | counseling skills and interventions |
1,605 | 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. | What defense mechanism is the client exhibiting when he talks to his mother about making friends? | Reaction formation | Denial | Rationalization | Projection | (A): Reaction formation
(B): Denial
(C): Rationalization
(D): Projection | Denial | B | By denying his feelings about how it makes him feel, he acts as if he does not care. Clients who engage in denial believe that expressing genuine emotion would make them vulnerable, so they mask their true feelings with an "I don’t care" façade. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
1,606 | 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. | You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated | If you suspect that the client may be intoxicated, all of the following are important considerations, EXCEPT: | Processing the client’s intoxication | Transportation home | Termination with the client | Continuing or ending the session | (A): Processing the client’s intoxication
(B): Transportation home
(C): Termination with the client
(D): Continuing or ending the session | Termination with the client | C | Termination would not be your primary concern when suspecting that this client is intoxicated. Although you may want to consider ending the current session, a discussion about termination would not be very helpful in the client’s current state and it does not support his needs at the moment. It is important to consider whether continuing the session is going to cause more harm, be helpful, or do nothing for the client. You do not know what the client is like when he uses inhalants; therefore, this could be a dangerous or harmful circumstance. You do need to consider how the client will get home if he is planning on driving and is unable to drive. It is important to know state laws because you may be liable if someone gets hurt when the client is driving home. It may be appropriate to try and process what led the client to use when he left the office because you might gain further insight into his condition. Therefore, the correct answer is (D) | professional practice and ethics |
1,607 | Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0) | Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng | You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially. | You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services. The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return | The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return. Which one of the following is the most ethical response? | There is nothing ethically wrong with working with this client again | Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy | The client should find a new therapist because you would be affected by bias if you reestablished the counseling relationship. But you can counsel her until she begins meeting with her new therapist. | You would not be able to provide counseling services without bias and should refer the client to another therapist if she needed to reinitiate counseling | (A): There is nothing ethically wrong with working with this client again
(B): Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy
(C): The client should find a new therapist because you would be affected by bias if you reestablished the counseling relationship. But you can counsel her until she begins meeting with her new therapist.
(D): You would not be able to provide counseling services without bias and should refer the client to another therapist if she needed to reinitiate counseling | Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy | B | There is nothing ethically wrong with working with a past client again, unless you think their current needs are outside of your scope of practice. Should symptoms worsen, your counseling would likely be very helpful for the client due to your already established rapport and familiarity with her issues. That said, it is important to encourage a client upon termination to recall the skills that were learned during your sessions as a means of preparing her for functioning and dealing with her symptoms independently. For that reason, the most appropriate response would be to first encourage her to use the learned coping skills should symptoms return, but to also reassure her that she will have access to you should those skills be insufficient. Bias is not a concern when a former client returns to counseling; rather, it would be an issue to consider should that former client request your counsel in the context of a family or a relationship, in which case you would have bias toward her over the rest of the group members. Therefore, the correct answer is (A) | professional practice and ethics |
1,608 | Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center | The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy. | First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance. Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies. While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties. In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time. Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step. After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group. Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates. Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans. Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in. One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.” Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially. Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation. | The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as "strained" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. | Given the client’s tearfulness as she describes her feeling of not belonging anywhere, how do you proceed? | Encourage her to make an appointment with a psychiatrist | Gently help her to analyze her cognitive distortions. | Create a list of situations in which she has felt a sense of belonging in the past | Normalize her emotive response | (A): Encourage her to make an appointment with a psychiatrist
(B): Gently help her to analyze her cognitive distortions.
(C): Create a list of situations in which she has felt a sense of belonging in the past
(D): Normalize her emotive response | Normalize her emotive response | D | The client has verbalized that she is lonely and has expressed feelings that she does not belong anywhere. Sharing these thoughts in session has evoked an intense emotional reaction, and the therapist should normalize and validate the client’s response. Rather than discounting the client’s experience, you let the client know she has been understood by providing an empathic response. Therefore, the correct answer is (C) | counseling skills and interventions |
1,609 | 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 | Autumn meets the criteria for? | Bulimia | Social anxiety | Avoidant/Restrictive Food Intake Disorder | Anorexia Nervosa | (A): Bulimia
(B): Social anxiety
(C): Avoidant/Restrictive Food Intake Disorder
(D): Anorexia Nervosa | Anorexia Nervosa | D | Autumn restricts her eating, has intense fear of gaining weight and purges by laxatives or over exercise, all symptoms of anorexia nervosa. Bulimia is ruled out due to lack of binge eating behaviors. Social anxiety is also ruled out as her social fears are limited to eating behaviors. Avoidant/restrictive intake disorder is ruled out because of Autumn's fear of gaining weight or becoming fat which is not a symptom in avoidant/restrictive intake disorder. Therefore, the correct answer is (B) | counseling skills and interventions |
1,610 | Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center | The client looks anxious and uneasy, presenting with a "nervous" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted. | First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling. He continues by telling you, "I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't." The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed. Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, "I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, "Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, "I can't concentrate right now. The anxiety of remembering my childhood is stressing me out." You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety. | The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from "under the thumb" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a "loser" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. | What is the optimal time to elicit your client's active involvement with their treatment plan? | During the initial session | Once he has gained insight into what is causing his anxiety | After he has successfully demonstrated progress by implementing one coping strategy | After his anxiety levels have stabilized | (A): During the initial session
(B): Once he has gained insight into what is causing his anxiety
(C): After he has successfully demonstrated progress by implementing one coping strategy
(D): After his anxiety levels have stabilized | During the initial session | A | The optimal time to elicit a client's active involvement with their treatment plan is as soon as they start attending sessions. Starting the therapeutic process by establishing an individualized treatment plan that functions as a roadmap for progress can help create structure and trust in the therapeutic relationship. Additionally, it can help ensure that both you and your client have clarity on what is expected of them, as well as their desired outcomes. Therefore, the correct answer is (C) | treatment planning |
1,611 | Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center | The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, "I don't want to talk about anything here." | First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been "in his business" all the time, and he does not feel like he has any real privacy. You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him. You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others. You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way. | The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed. Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. | Rick, from his current experience living at home with his overprotective Korean mother, is afraid that she will want to know everything that goes on during your counseling sessions. What would you say as a clinician to Rick regarding what she has access to? | Explain to Rick that his mother will not have access to the conversations that take place in the counseling session. | Explain to Rick that his discomfort concerning his mother is part of his diagnosis and begin to unpack his feelings and motivations. | Explain to Rick that he can disclose what he wishes to his mother but that his mother cannot contact you directly. | Explain to Rick that it is his mother's right to know what is discussed in the counseling session since he is in high school and lives at home. | (A): Explain to Rick that his mother will not have access to the conversations that take place in the counseling session.
(B): Explain to Rick that his discomfort concerning his mother is part of his diagnosis and begin to unpack his feelings and motivations.
(C): Explain to Rick that he can disclose what he wishes to his mother but that his mother cannot contact you directly.
(D): Explain to Rick that it is his mother's right to know what is discussed in the counseling session since he is in high school and lives at home. | Explain to Rick that his mother will not have access to the conversations that take place in the counseling session. | A | Though the client is still in high school and living at home, he is 18 and considered an adult. His mother will not have access to the conversations that take place in the counseling session. Therefore, the correct answer is (D) | professional practice and ethics |
1,612 | 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 | Once a core belief is identified, which cognitive restructuring technique would you select to help reduce psychological distress? | Role reversion | Identify the “three basic musts” | Shame-attacking exercises | Ask exception questions | (A): Role reversion
(B): Identify the “three basic musts”
(C): Shame-attacking exercises
(D): Ask exception questions | Role reversion | A | Cognitive therapists use role reversion to challenge negative cognitions, therefore reducing psychological distress. Role reversion works by instructing clients to switch roles with the counselor and argue against the client’s hypothesis associated with distorted thinking. Shame-attacking exercises are REBT techniques designed to be performed in public to reduce the need for others’ approval. The theory behind shame-attacking exercises is that by reducing the need for approval, there is also a reduction in catastrophic thinking that fosters feelings of inadequacy. Identifying the three basic musts, or irrational beliefs, is an REBT technique. The three basic musts include (1) believing one must perform in a manner that others affirm or else one is void of self-worth, (2) believing one must be treated in a manner that the client finds affirming or else one is labeled “no good,” and (3) believing that one must get what they think they are entitled to or that one’s life is unacceptable. Exception questions are a solution-focused technique used to explore times in the client’s life when the problem did not exist, thus creating optimism, hope, and the potential for recreating those experiences. Therefore, the correct answer is (C) | counseling skills and interventions |
1,613 | 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. | How could you ask the client if substance use is a problem and demonstrate a non-judgmental stance at the same time? | "Substance use is not your fault; it is a medical condition you should not be ashamed of. | What leads you to believe that you are incapable of controlling your drinking? | "How could substance use possibly play a role in your current situation?" | "In order to tackle your drinking issue, where do you suggest we begin our treatment?" | (A): "Substance use is not your fault; it is a medical condition you should not be ashamed of.
(B): What leads you to believe that you are incapable of controlling your drinking?
(C): "How could substance use possibly play a role in your current situation?"
(D): "In order to tackle your drinking issue, where do you suggest we begin our treatment?" | "How could substance use possibly play a role in your current situation?" | C | This is not accusatory nor is it judgmental. It is also open-ended, allowing for multiple options as answers. It gives the client a chance to think about the issue and then respond with a more thoughtful answer without being on the defensive. Therefore, the correct answer is (B) | counseling skills and interventions |
1,614 | Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss | First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a "bad group of kids." The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying. The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no "real" friends, and hates her life. The client sighs heavily, saying, "Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is "stuck in a dark hole" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings. After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week. | The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. | What would you explore in order to gather information about the client's level of functioning? | Ask the client's mother | Administer an in-depth survey | Explore relationships with her peer group | Engage the client in an in-depth role-play regarding peer interactions | (A): Ask the client's mother
(B): Administer an in-depth survey
(C): Explore relationships with her peer group
(D): Engage the client in an in-depth role-play regarding peer interactions | Explore relationships with her peer group | C | The client's level of functioning within her peer group is indicative of her ability to relate in general. Therefore, the correct answer is (B) | counseling skills and interventions |
1,615 | Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual | The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress. Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm. | You are a counselor in a community mental health agency setting. Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.” He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off. | Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth. | After identifying his unhelpful core belief, which of the following cognitive behavioral theory (CBT) interventions should be implemented during this session? | Practice the "empty chair" to help client challenge his negative core belief | Explore client's ability to challenge automatic thoughts using the "downward arrow" | Explore client's automatic negative thoughts and cognitive distortions | Practice relaxation techniques to help client reduce anxiety about friendships | (A): Practice the "empty chair" to help client challenge his negative core belief
(B): Explore client's ability to challenge automatic thoughts using the "downward arrow"
(C): Explore client's automatic negative thoughts and cognitive distortions
(D): Practice relaxation techniques to help client reduce anxiety about friendships | Explore client's automatic negative thoughts and cognitive distortions | C | Unhelpful core beliefs are supported by automatic negative thoughts and cognitive distortions. Exploring these helps the client gain insight into how his core beliefs are maintained and how he can begin to change them, which will help modify the unhelpful core belief. The "empty chair" is not a CBT intervention. The "downward arrow" is a helpful CBT intervention that is used to identify unhelpful core beliefs. The belief has already been identified and other interventions are used to begin modifying it. Relaxation techniques can be helpful for clients who are experiencing acute anxiety. This client does not present as anxious during this session so beginning to work on his core beliefs will be most effective at the moment. Therefore, the correct answer is (C) | counseling skills and interventions |
1,616 | Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual | The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry. Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now. Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices. | You are a counselor in a community mental health agency. The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch. The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.” She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high. | Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.” | Based on the information gained in the intake, the counselor should be continually aware of? | Client's manipulation of the counselor | Counselor's inability to remain objective about the client | Client's thoughts of harm to self or others | All of the above | (A): Client's manipulation of the counselor
(B): Counselor's inability to remain objective about the client
(C): Client's thoughts of harm to self or others
(D): All of the above | All of the above | D | All of the above are important for the counselor when working with this client. Clients who are mandated to counseling often feel coerced into counseling and tend to be extrinsically motivated in order to achieve their desired outcome, in this client's case, to move back into her parents' home. Externally motivated clients may manipulate by not telling the whole story or playing the victim to increase sympathy from others. Important characteristics of counselors include empathy and positive regard. When working with a client who is manipulative, triggers counselor countertransference or over-sympathizing that impacts the session, or the counselor begins to make character judgements about people in the client's life who the counselor has not met, the counselor has lost the ability to be objective and cannot appropriately counsel the client. As the client has a history of thinking about harming others, poor insight, poor judgement, it will be necessary for the counselor to accurately assess mood, affect, and thoughts of harm during each session. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
1,617 | 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. | Which of the following will be the best tool to help the client find a good fit between her personality and a work environment? | What Color Is Your Parachute | Holland's Self-Directed Search (SDS) | Strong's Interest Inventory (SII) | Savickas' Career Style Interview (CSI) | (A): What Color Is Your Parachute
(B): Holland's Self-Directed Search (SDS)
(C): Strong's Interest Inventory (SII)
(D): Savickas' Career Style Interview (CSI) | Holland's Self-Directed Search (SDS) | B | Holland's SDS is based on his theory of personality as it relates to career choice. His widely-used theory and test suggest that occupations and work environments have characteristics that appeal to particular personality types. By matching types, the client would be most likely to find an occupation and work environment that matches her personality. The book What Color Is Your Parachute is a best-selling job hunting book, but will not help the client match her personality to an occupation or work environment. The SII was developed as an interest inventory and helps the test-taker to explore their potential areas of study, careers, and leisure interests. It focuses on one's work style, learning environment, team orientation, leadership style, and risk taking. The CSI is a structured interview based on Adlerian and constructivist theories that help clients resolve career problems. It is not meant to match client's personalities to work environments or occupations, but to help clients resolve problems that hinder them in their career. Therefore, the correct answer is (C) | counseling skills and interventions |
1,618 | Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00) | Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam | You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her. | The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client. You search for randomized clinical trials to determine the efficacy of distance counseling for agoraphobia | You search for randomized clinical trials to determine the efficacy of distance counseling for agoraphobia. Which one of the following best ensures that a study’s conclusions are free from bias? | On-treatment analysis | Intention-to-treat analysis | Transactional analysis | Per-protocol analysis | (A): On-treatment analysis
(B): Intention-to-treat analysis
(C): Transactional analysis
(D): Per-protocol analysis | Intention-to-treat analysis | B | In addition to randomization, an intention-to-treat analysis best ensures that a study’s conclusions are free from bias. An intention-to-treat analysis uses conclusions based on keeping all subjects in the treatment group they were randomized to, independent of what occurs later in the experiment. In other words, for randomized clinical trials, if half of the subjects dropped out of the study or conditions changed that affected their participation, they were still counted despite deviation from the protocol. A per-protocol analysis is the opposite of an intention-to-treat analysis. A per-protocol analysis excludes subjects who deviated from the protocol. If conducted alone, this analysis is subject to attrition bias. Transactional analysis is a psychoanalytic counseling theory used to analyze social transactions to determine one’s ego state. Unlike intention-to-treat analysis, on-treatment analysis only includes data on subjects who received the treatment they were randomized to—those who deviated from the protocol were not counted. Therefore, the correct answer is (C) | professional practice and ethics |
1,619 | 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. During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum | During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum. Based on behavioral therapy, which of the following would be considered the function of this behavior? | Escape | Attention seeking | Sensory | Tangible | (A): Escape
(B): Attention seeking
(C): Sensory
(D): Tangible | Tangible | D | These terms are often used as part of applied behavior analysis, and, in this situation, the function of behavior is for a tangible item. The client is seeking a snack and was denied one, so his behavior’s function is to push his parents to get frustrated, give in to his behavior, and provide what he wants. The counselor’s response to this would be to encourage more effective and appropriate manners of expressing his wants and needs. The behavior can be rewarded when he appropriately advocates for his wants and needs. It is possible that the request for a snack is to escape the session. However, the behavior was clearly escalated when he was denied the snack, so the behavior was more about being denied the item. The client is not requesting the snack for attention-seeking purposes, demonstrated by his strong reaction to not being able to have one at that moment. Generally, attention-seeking behavior is focused primarily on the attention, rather than the outcome of the request or behavior. In this scenario, the client is already the center of attention in the session. Therefore, the correct answer is (A) | counseling skills and interventions |
1,620 | Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5) | Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam | You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns. | The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter | What are the ethical implications for seeing both the client and his wife during the scheduled therapy session with the client? | An ethical violation was not committed because there is implied consent due to the client being present with his wife. | An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling. | An ethical violation was committed because the client is the identified patient and has not waived his right to confidentiality. | An ethical violation was not committed since safely de-escalating conflict creates an exception and allows confidentiality to be breached. | (A): An ethical violation was not committed because there is implied consent due to the client being present with his wife.
(B): An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling.
(C): An ethical violation was committed because the client is the identified patient and has not waived his right to confidentiality.
(D): An ethical violation was not committed since safely de-escalating conflict creates an exception and allows confidentiality to be breached. | An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling. | B | According to the ACA Code of Ethics (2014):“When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. […] Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. […] Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information”The issue of implied consent is valid for collateral contacts and may meet minimal ethical requirements; however, without a signed informed consent delineating your role and relationship with each participant, you may encounter ethical complications. The client initially allowed contact with his wife to obtain collateral information. The wife reported that she wanted to attend couples therapy, but the client was adamant that she did not participate. This brings into question the client’s capacity to provide voluntary consent (ie, it may be given under duress and thus invalid). Since conflict de-escalation in couples therapy is standard practice, this does not create an exception. The counselor did not commit an ethical violation due to the client not waiving his right to confidentiality. The issue lies with informed consent as a whole rather than one aspect of informed consent. Confidentiality is one aspect of informed consent. Therefore, the correct answer is (D) | professional practice and ethics |
1,621 | Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice | The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes "doesn't feel like existing" when thinking about her injury. She shares that the thought of not being able to dance ever again is "too much to bear." Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support. | First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork. Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and "snaps" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, "She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care." After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her "life is ruined now" and "I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed." She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents. Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, "Why should I tell you anything else? You'll just tell my parents." You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, "Okay, I get what you're saying, but telling them about it has only made things worse." She reports that her parents now treat her "differently" and do not allow her access to any "dangerous items like kitchen knives" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, "I guess I can understand why they did it, but it still doesn't feel fair." You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them. You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, "I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been." You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, "I don't know...I've never really thought of myself as a teacher. I've always been the student." You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students. | 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. | Which of the following is the best way to address the client's concerns about confidentiality? | Apologize to the client; assure her that you will never make this mistake again | Empathize and explore the client's emotions; Clearly state why you had to communicate with her parents; Ask the client how you can collaboratively help her resolve this issue with her parents | Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents | Explain why you had to communicate this issue to her parents; Ask her to imagine the situation from her parents' perspective and how she would want to know if her child was in pain | (A): Apologize to the client; assure her that you will never make this mistake again
(B): Empathize and explore the client's emotions; Clearly state why you had to communicate with her parents; Ask the client how you can collaboratively help her resolve this issue with her parents
(C): Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents
(D): Explain why you had to communicate this issue to her parents; Ask her to imagine the situation from her parents' perspective and how she would want to know if her child was in pain | Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents | C | This answer is the most comprehensive demonstration of conflict resolution skills. It fully demonstrates excellent the conflict resolution skills of listening to the client, clearly communicating your position, and apologizing for the misunderstanding (the client thinking that "everything" she told you would remain confidential). Therefore, the correct answer is (C) | professional practice and ethics |
Subsets and Splits