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1 | Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual | Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a trau... | Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by he... | Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily i... | As a culturally competent counselor, how should you respond to Malik's gift? | I appreciate the sentiment, but I am not allowed to accept gifts. | This is so sweet! But you should keep them, I'm on a diet! | I can't keep them, but let's open them now and share them together. | Mahalo! This is lovely. Thank you for thinking of me. | (A): I appreciate the sentiment, but I am not allowed to accept gifts.
(B): This is so sweet! But you should keep them, I'm on a diet!
(C): I can't keep them, but let's open them now and share them together.
(D): Mahalo! This is lovely. Thank you for thinking of me. | Mahalo! This is lovely. Thank you for thinking of me. | D | It is of significance in Hawaiian and many other cultures to bring gifts from one's homeland, sending the message of affection or respect while showcasing and representing the beauty and history of one's culture. Knowing and understanding the meaning behind small gestures and further being able to communicate using com... | professional practice and ethics |
2 | Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location ... | The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and... | First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks ... | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of mothe... | Taking into consideration what you have learned during the session, what is most important for you to consider when choosing an initial treatment modality for the client? | The client's preference regarding pharmacological intervention | The client's status as a stay-at-home mother | The client's relationship with her husband | The client's therapeutic expectations | (A): The client's preference regarding pharmacological intervention
(B): The client's status as a stay-at-home mother
(C): The client's relationship with her husband
(D): The client's therapeutic expectations | The client's preference regarding pharmacological intervention | A | Of these options, the client's preference regarding pharmacological intervention is most important when choosing an initial treatment modality for the client. It is important to ensure that the client is comfortable with any medications prescribed and that the client has an understanding of possible side effects and is... | treatment planning |
3 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0) | Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesit... | You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client ... | The client contacted you to reschedule a session sooner than the one you had originally scheduled. The client reported that he continues to have difficulty getting to work on time and was told that he needs to meet with his supervisor on Friday. The client expresses anxiety surrounding this because he worries about get... | Due to increased anxiety and depressive symptoms, you choose to use CBT techniques. Which of the following would be an intervention used in CBT? | Cognitive restructuring or reframing | Assess for readiness for change | Operant conditioning | Reality acceptance | (A): Cognitive restructuring or reframing
(B): Assess for readiness for change
(C): Operant conditioning
(D): Reality acceptance | Cognitive restructuring or reframing | A | CBT is based around cognitive restructuring and reframing, which can be a very effective intervention for anxiety or depression. Reality acceptance is part of dialectical behavior therapy and would not be as beneficial for this client because the anxiety is based around an unknown outcome. Assessing readiness for chang... | counseling skills and interventions |
4 | Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3) | Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that refl... | You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her act... | You are meeting with the client individually and providing parenting training with the client’s PGM. The client’s teacher has implemented a behavioral chart for the classroom, and you ensure the client is receiving appropriate reinforcement for targeted behaviors. The teacher believes the client’s behavior indicates AD... | Which instrument would you select to further assess the client’s social and emotional problems, including DSM-specific disorders such as ADHD, ODD, and other conduct problems? | The Brief Symptoms Inventory-18 (BSI-18) | The Woodcock-Johnson IV (WJ IV) | The Conners’ Third Edition (Conners 3) | The Achenbach Child Behavior Checklist (CBCL) | (A): The Brief Symptoms Inventory-18 (BSI-18)
(B): The Woodcock-Johnson IV (WJ IV)
(C): The Conners’ Third Edition (Conners 3)
(D): The Achenbach Child Behavior Checklist (CBCL) | The Achenbach Child Behavior Checklist (CBCL) | D | The Achenbach Child Behavior Checklist (CBCL) helps detect social and emotional problems, including disorders such as ADHD, ODD, and other conduct problems. The CBCL detects DSM-specific symptoms in the following six categories: affective problems, anxiety problems, somatic problems, ADHD, oppositional defiant problems... | intake, assessment, and diagnosis |
5 | Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple | The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasti... | You are a counselor in a private practice setting. Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marri... | Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in base... | Which of the following counseling skills or interventions should be used during this session? | Redirecting John's attention to Jane's distress | Exploring both families of origin patterns and themes | Psychoeducation on relaxation techniques for John and Jane | Summarizing John's fears about infertility and loss | (A): Redirecting John's attention to Jane's distress
(B): Exploring both families of origin patterns and themes
(C): Psychoeducation on relaxation techniques for John and Jane
(D): Summarizing John's fears about infertility and loss | Summarizing John's fears about infertility and loss | D | During the individual interview, John openly discussed fears of his own infertility and the loss he would feel if he could not have a child. Because he has not been communicating with Jane, this would be important to summarize with John so that Jane can become more aware of his fears and emotional reaction to their inf... | counseling skills and interventions |
6 | Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual | The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene. Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and c... | You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells yo... | Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelt... | Which of the following referrals will be most helpful in treating the client's hoarding disorder? | Refer client to psychiatry for medication evaluation | Refer client to local government services for evaluation of adequate housing | Refer client to behavioral health to determine client's competency to make decisions | Refer client to a professional organizer who can help organize the client's home | (A): Refer client to psychiatry for medication evaluation
(B): Refer client to local government services for evaluation of adequate housing
(C): Refer client to behavioral health to determine client's competency to make decisions
(D): Refer client to a professional organizer who can help organize the client's home | Refer client to psychiatry for medication evaluation | A | Referring the client to psychiatry will be most helpful for treating the client's hoarding disorder due to the components of depression, OCD, and ADHD that are often co-occurring with hoarding disorder. Treatment with SSRIs is helpful in treating those with hoarding disorder. Referring to a professional organizer will ... | counseling skills and interventions |
7 | Initial Intake: Age: 23 Gender: Male Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his e... | Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back... | Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his prob... | You teach Shawn the cognitive strategy of labeling his negative thoughts while they are occurring in his mind in an emotionally detached manner and guide him in applying mindful observations without judging himself. This is an example of? | Thought Responding | Thought defusion | Oral Cognitive Restructuring | Paradoxical Repetition | (A): Thought Responding
(B): Thought defusion
(C): Oral Cognitive Restructuring
(D): Paradoxical Repetition | Thought defusion | B | Thought defusion is applying mindful observation of your negative thoughts, then labeling your negative thoughts while they are occurring in your mind and reflecting on them unemotionally and without judgment ("For the moment, I'm having an anxious feeling, but it will pass eventually"). Then, instead of trying to rest... | counseling skills and interventions |
8 | Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Mar... | The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes ele... | First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client know... | The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while he... | Which treatment objective would provide the client with long-term relief from her stress and anxiety? | Mastering deep breathing techniques during stressful situations | Identifying time-management skills and mindfulness techniques | Learning how to implement positive self-talk in times of stress | Increasing emotional resilience and problem-solving skills | (A): Mastering deep breathing techniques during stressful situations
(B): Identifying time-management skills and mindfulness techniques
(C): Learning how to implement positive self-talk in times of stress
(D): Increasing emotional resilience and problem-solving skills | Increasing emotional resilience and problem-solving skills | D | Increasing emotional resilience and problem-solving skills would provide the client with long-term relief from her emotional symptoms. She struggles with anxiety and depression related to taking on the role of caregiver for her mother and having her mother live in the family home. Therefore, the correct answer is (A) | treatment planning |
9 | 7 Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual | Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccup... | Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passe... | llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupat... | Millie admits to abusing pain medication prescribed by her doctor for treating medical issues, as well as getting high on inhalants in her room at her grandparents' house. What is your next step? | Educate Millie on the harmful effects of substance abuse. | Inform her father and grandparents for her own safety. | Prepare Millie for a referral to a higher level of care. | Call 911 to have Millie expedited to detox. | (A): Educate Millie on the harmful effects of substance abuse.
(B): Inform her father and grandparents for her own safety.
(C): Prepare Millie for a referral to a higher level of care.
(D): Call 911 to have Millie expedited to detox. | Prepare Millie for a referral to a higher level of care. | C | Unless Millie is experiencing an overdose, incapacitated, or in danger of harming herself or others, calling 911 is not necessary and you can work with Millie on understanding what the next steps would be for entering into a higher level of care should she choose to comply with your recommendations. Education, as in an... | treatment planning |
10 | Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Loc... | The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the dis... | First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and disc... | The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had "hi... | Given the nature of your relationship in the school setting, and the time you realistically can allot to the client, as well as her age and maturity level, which approach will you initially use to engage the client in the therapy process? | Person-centered therapy | Solution-focused brief therapy | Reality therapy | Cognitive-behavioral therapy | (A): Person-centered therapy
(B): Solution-focused brief therapy
(C): Reality therapy
(D): Cognitive-behavioral therapy | Person-centered therapy | A | The client is in a vulnerable state right now. Using a person-centered approach and practicing unconditional positive regard, genuineness, and empathic understanding will help you establish trust with her. Therefore, the correct answer is (C) | counseling skills and interventions |
11 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express | You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The ... | The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engagin... | The client identified that one thought he had during sex was “I feel inadequate as a man; therefore, I must be inadequate because I can’t fully satisfy my girlfriend.” Which of the following cognitive distortions best defines this thought? | Overgeneralization | Fortune-telling | All-or-nothing thinking | Emotional reasoning | (A): Overgeneralization
(B): Fortune-telling
(C): All-or-nothing thinking
(D): Emotional reasoning | Emotional reasoning | D | Emotional reasoning is the cognitive distortion displayed here because the client is accepting his emotion as a reality even though just feeling something does not make it true. The client is not experiencing all-or-nothing thinking because he is not experiencing polarized thinking. The client is not fortune-telling be... | counseling skills and interventions |
12 | Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and... | The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhib... | First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, "He was beaten to death because he was transgender." The attack occurred a week ago,... | The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, "It was like my dad leaving us... | Using a cognitive-behavioral approach, what technique could help your client through the thoughts she is dealing with by feeling she is responsible for her friend's death? | Exploration of family constellation | Reattribution | "Acting as if" | Psychodrama | (A): Exploration of family constellation
(B): Reattribution
(C): "Acting as if"
(D): Psychodrama | Reattribution | B | Reattribution is a CBT technique which takes a situation and examines the automatic thought by considering alternatives for the events under consideration. Therefore, the correct answer is (C) | counseling skills and interventions |
13 | Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual | Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question ... | Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his... | Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class,... | Despite your possible feelings about Raul's mother's parenting skills, you smile with her as she shares information and offer her kindness and support. What is this practice called? | Fake it 'til you make it | Positive psychology | Emotional restraint | Unconditional positive regard | (A): Fake it 'til you make it
(B): Positive psychology
(C): Emotional restraint
(D): Unconditional positive regard | Unconditional positive regard | D | This is a core competency of counselors and demands a non-judgmental stance. Therapy is intended to offer a client a different experience than they have ever had; offering compassion and positive regard makes it easier on the client to communicate their needs, feelings, fears, desires, and concerns. Answer b) is not a ... | core counseling attributes |
14 | Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality:... | Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age. | First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very... | Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect tow... | What follow-up recommendation would be most beneficial for the client? | Periodic check-in sessions | Assign a case manager to call him when he is at home | Pediatrician checkup | Involvement in specialized group therapy | (A): Periodic check-in sessions
(B): Assign a case manager to call him when he is at home
(C): Pediatrician checkup
(D): Involvement in specialized group therapy | Periodic check-in sessions | A | Although you believe the client is ready for termination, this process can be a difficult adjustment. Being available for periodic check-in sessions following the termination will increase the client's ability to maintain the progress he made in therapy. Therefore, the correct answer is (B) | treatment planning |
15 | Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with t... | Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation | You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she s... | The client comes in, sits down, and immediately says that she has been thinking and decided that she is now ready to talk about the physical abuse that she has experienced. She recounts that from age 18 until age 20 she was with a boyfriend who would smack her if she said something he did not like. She believes this is... | Your informed consent includes fees for nonpayment and late cancellations of sessions. Which of the following is the most therapeutic response to the client’s inability to pay for the session until the end of the week? | Allow the client until the end of the week to pay for the cost of the session with the added fee. | Waive the session fee and nonpayment fee because the client is experiencing financial hardship. | Allow the client until the end of the week to pay for the session and waive the nonpayment fee. | Consistency with fees is important in the client–counselor relationship. The fee should still be applied, and payment is still expected on time | (A): Allow the client until the end of the week to pay for the cost of the session with the added fee.
(B): Waive the session fee and nonpayment fee because the client is experiencing financial hardship.
(C): Allow the client until the end of the week to pay for the session and waive the nonpayment fee.
(D): Consistenc... | Allow the client until the end of the week to pay for the session and waive the nonpayment fee. | C | Because this client has no history of nonpayment, it would be the most therapeutic course of action to waive the nonpayment fee and allow the client extra time to pay for the session. Generally speaking, fees for the counseling sessions, for late cancellations, and for nonpayment are beneficial for the counselor and th... | professional practice and ethics |
16 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Engaged Counseling Setting: Agency - Telehealth Type of Counseling: Individual | Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and ... | Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9)
You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt... | Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resen... | What should you do at this stage of the session? | Align with her empathically and wait for her to be ready to engage undistracted | Inform her the session will be a waste of a Medicaid billing hour and she should reschedule | Explain how her children being present is inappropriate and a violation of HIPAA | Call Department of Family Services to report emotional abuse of children | (A): Align with her empathically and wait for her to be ready to engage undistracted
(B): Inform her the session will be a waste of a Medicaid billing hour and she should reschedule
(C): Explain how her children being present is inappropriate and a violation of HIPAA
(D): Call Department of Family Services to report em... | Align with her empathically and wait for her to be ready to engage undistracted | A | In order to build rapport, safety, and trust with this client, especially through a telemedicine platform, it is important to demonstrate concern for her emotional wellbeing and to prioritize your therapeutic relationship. A parent yelling in frustration at her children is not enough evidence to support a claim of emot... | professional practice and ethics |
17 | Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional | Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express | You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The ... | The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as e... | You have provided support for your counseling intern, and he continues to be late for and miss client sessions. Which of the following would meet ACA criteria for ethical considerations at this point? | You see this as an opportunity to support the intern in balancing his personal life and his professional life. | You seek consultation and document your decision to terminate your supervisory relationship with the intern. | You encourage the intern to seek counseling in order to work through what he is going through. | You provide a corrective action plan to the intern in order to prevent further issues with his clients. | (A): You see this as an opportunity to support the intern in balancing his personal life and his professional life.
(B): You seek consultation and document your decision to terminate your supervisory relationship with the intern.
(C): You encourage the intern to seek counseling in order to work through what he is going... | You seek consultation and document your decision to terminate your supervisory relationship with the intern. | B | At this point, documenting the consultation and terminating the relationship would be indicated because the intern is continuing to harm clients (ACA, 2014, p 13). You have already tried to support the intern, and it was not helpful in preventing client harm or changing his behavior. At this point, a corrective action ... | professional practice and ethics |
18 | Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location o... | The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, "even though there is nothing to be angry about." You do not observe any... | First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session t... | null | After the client shares his revelation, you state, "It's impressive that you were able to make the connection between your road rage and feeling taken advantage of by your children." What are you attempting to do with this response? | Empower the client | Provide Unconditional Positive Regard | Demonstrate congruence | Engage the client in therapy | (A): Empower the client
(B): Provide Unconditional Positive Regard
(C): Demonstrate congruence
(D): Engage the client in therapy | Empower the client | A | Affirmation is a form of encouragement that is used to affirm behaviors or life choices. Affirmation is important for empowering clients. A few common affirmations include affirming progress that a client has made toward a goal or encouraging a client to do what is important to him. Therefore, the correct answer is (C) | counseling skills and interventions |
19 | Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual | Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was neve... | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a mi... | Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record wi... | You respond to Davone saying “You are clearly disappointed, and obviously hurt as well! I can't imagine not being able to see my children. It would be so hard.” This is an example of? | reflection | empathy | sympathy | direct correlation | (A): reflection
(B): empathy
(C): sympathy
(D): direct correlation | empathy | B | Validating your client's presentation and feelings while attuning to their emotional condition can strengthen your therapeutic bond and help them to feel heard and understood. Offering sympathy shows pity for your client but does not accomplish the congruence that empathy does and maintains an emotional distance from y... | counseling skills and interventions |
20 | Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location ... | The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and... | First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks ... | The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom. For the past year, the client has reported feeling overwhelmed with the demands of mothe... | Which of the following would be the least appropriate response to the client's disclosure? | "It's understandable that you have a fear of dying and leaving your children. It's natural to think about the worst-case scenario. Can you tell me more about this fear?" | "Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are taken care of. But, on the other hand, your fear paralyzes and prevents you from living your life to the fullest. What do you think?" | "It sounds like you have some substantial concerns about dying. Can you tell me more about why your fear around this subject is so strong?" | "I also had a fear of dying for a long time. I think my fear came from a combination of my childhood experiences and denying my mortality. Do any events from your childhood come to mind that might be related to your fears?" | (A): "It's understandable that you have a fear of dying and leaving your children. It's natural to think about the worst-case scenario. Can you tell me more about this fear?"
(B): "Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are ... | "Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are taken care of. But, on the other hand, your fear paralyzes and prevents you from living your life to the fullest. What do you think?" | B | This is not the best way to respond to a client's fear of dying as it does not provide any strategies to help the client cope with their fear. It also does not acknowledge the client's feelings or provide any support or reassurance. Therefore, the correct answer is (C) | professional practice and ethics |
21 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family | Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suici... | Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
You are an intern providing mental health counseling... | Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not t... | Would it be appropriate for you to provide counseling for both Shania and Malia? | Yes, because you can always provide therapy for both parent and child. | No, because you need a child psychology degree to work with a child. | No, since you can never be the counselor for both a parent and child. | Yes, because this is the nature of your job at this company. | (A): Yes, because you can always provide therapy for both parent and child.
(B): No, because you need a child psychology degree to work with a child.
(C): No, since you can never be the counselor for both a parent and child.
(D): Yes, because this is the nature of your job at this company. | Yes, because this is the nature of your job at this company. | D | In this scenario your counseling position is to provide services to individuals and their family members. General counseling ethics will guide your boundary making decisions with every case, however in this unique circumstance you are the case worker for the entire family which makes seeing them together appropriate. I... | professional practice and ethics |
22 | Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Mo... | The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic ... | First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is han... | The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but "my stepfather is a different story." She reports that he is critical of her and often remarks on how she looks or ... | Based on best practices for family therapy, how would you recommend structuring future sessions with the client and her parents? | Propose bringing in a co-therapist to take the stepfather for individual work while you continue with the client and mother. | Decline any further joint sessions to avoid exposing the client to further harm and conflict. Only meet with her individually. | Hold joint sessions to resolve conflicts and teach communication skills together. | Suggest individual sessions for each, then small joint sessions with the client and mother before full family sessions. | (A): Propose bringing in a co-therapist to take the stepfather for individual work while you continue with the client and mother.
(B): Decline any further joint sessions to avoid exposing the client to further harm and conflict. Only meet with her individually.
(C): Hold joint sessions to resolve conflicts and teach co... | Suggest individual sessions for each, then small joint sessions with the client and mother before full family sessions. | D | Starting with individual sessions allows each family member to work on their concerns separately, optimizing progress. Small joint sessions for the client and mother can nurture their relationship before engaging the stepfather. This staged approach minimizes the risks of re-traumatization. Therefore, the correct answe... | professional practice and ethics |
23 | 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 insi... | 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 ... | 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 ... | The client discloses that he has recently taken up boxing to release pent-up energy. This is an example of which one of the following? | Sublimation | Regression | Rationalization | Reaction formation | (A): Sublimation
(B): Regression
(C): Rationalization
(D): Reaction formation | Sublimation | A | Taking up boxing to release pent-up energy is an example of sublimation. Sublimation, rationalization, reaction formation, and regression are all defense mechanisms. Defense mechanisms are unconscious means for protecting a person from overwhelming feelings of anxiety. Sublimation occurs when a person redirects unaccep... | counseling skills and interventions |
24 | Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therap... | The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye co... | First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that y... | The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to ... | The wife's reaction to the loss of her husband's income is an example of which cognitive error? | Catastrophizing | Mental Filtering | Overgeneralization | Polarization | (A): Catastrophizing
(B): Mental Filtering
(C): Overgeneralization
(D): Polarization | Catastrophizing | A | Catastrophizing is the cognitive error of automatically expecting the worst-case scenario to occur. In this case, the client is jumping to the conclusion that she will lose her mortgage and health insurance and have to sell everything without considering other potential solutions or outcomes. Therefore, the correct ans... | intake, assessment, and diagnosis |
25 | Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual... | The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hes... | First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month... | null | What is the best way to demonstrate empathic attunement in response to the client's fear of her family's disapproval? | "What would you advise another person in your situation to do?" | "It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs." | "How would you feel about role playing a conversation with your family about your relationship? This might help alleviate some of the anxiety that you're feeling." | "You're not alone in this experience and what you're feeling is valid." | (A): "What would you advise another person in your situation to do?"
(B): "It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs."
(C): "How would you feel about role playing a conversation with your family abou... | "It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs." | B | This is an example of empathic understanding because it acknowledges the client's feelings and validates her concerns without passing judgment. It shows that the therapist understands the difficulty of navigating family expectations, while also affirming the client's autonomy to make decisions about her own life. This ... | core counseling attributes |
26 | 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 un... | 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 t... | ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked fo... | You use a biopsychosocial assessment during the client’s initial intake appointment. Which one of the following uses a holistic approach to address a client’s biopsychosocial and spiritual dimensions? | Humanistic | Behavioral | Cognitive-behavioral | Psychoanalytic | (A): Humanistic
(B): Behavioral
(C): Cognitive-behavioral
(D): Psychoanalytic | Humanistic | A | A humanistic style uses a holistic approach to address a client’s biopsychosocial and spiritual dimensions. Humanistic theories include person-centered therapy, gestalt therapy, and existential therapy. CBT’s primary focus is to help clients change thought patterns characterized by erroneous, irrational, or negative be... | counseling skills and interventions |
27 | Initial Intake: Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual | Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife. | Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.
History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and... | null | Theodore decides that he would like to tell Nate about his decision to not move in with him. A Gestalt technique in which Theodore can practice, by playing both sides of the conversation, would be? | Role playing | Empty chair technique | Rehearsal technique | Drama therapy | (A): Role playing
(B): Empty chair technique
(C): Rehearsal technique
(D): Drama therapy | Empty chair technique | B | The empty chair technique is a Gestalt technique in which Theodore practices the conversation between him and Nate. This can show the counselor the expectations that Theodore has of Nate. This technique is also used in counseling for internal conflicts where an individual may have a conversation with a part of themselv... | counseling skills and interventions |
28 | Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Loc... | The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client rep... | First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client... | The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of... | Using an Adlerian approach, what technique might be most appropriate for this client in light of the client's most recent revelations regarding his extra affairs? | Push button technique | Guided imagery | "Spitting in the client's soup" | Empty chair | (A): Push button technique
(B): Guided imagery
(C): "Spitting in the client's soup"
(D): Empty chair | "Spitting in the client's soup" | C | The Adlerian technique "spitting in the client's soup" can be used to bring awareness to a persistent pattern of negative behavior (ex. the client having affairs while saying he wants to enjoy a sexual relationship with his wife). Therefore, the correct answer is (B) | counseling skills and interventions |
29 | Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location o... | The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation.... | First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings th... | The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks... | When talking to the wife, you tell her that sometimes you take a break from your own marriage by taking a "mini-vacation" for a weekend. What are you doing here? | Using self-disclosure | Summarizing the client's statements | Empowering the client | Demonstrating respect for the client's autonomy | (A): Using self-disclosure
(B): Summarizing the client's statements
(C): Empowering the client
(D): Demonstrating respect for the client's autonomy | Using self-disclosure | A | You are disclosing personal information to the client. As a therapist, you can self-disclose as long as you do not take away from the client and as long as your self-disclosure is appropriate to the client's situation. Therefore, the correct answer is (A) | professional practice and ethics |
30 | Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is a... | Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem | You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost ab... | You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of t... | Which of the following indicates that this client is ready for termination? | The client reports that no symptoms of the eating disorder or trauma are present, and you also observe no symptoms. | The client states that she is not restricting, bingeing, or purging and that she and her husband are going to start couples counseling. | The client has nothing to talk about in sessions and reports that she does not have anything she needs to work on. | Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur. | (A): The client reports that no symptoms of the eating disorder or trauma are present, and you also observe no symptoms.
(B): The client states that she is not restricting, bingeing, or purging and that she and her husband are going to start couples counseling.
(C): The client has nothing to talk about in sessions and ... | Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur. | D | It is not always realistic to expect all symptoms to be abated. When minimal symptoms are present and the client is able to manage them and maintain progress, termination is appropriate. Although no symptoms being present is the ideal, this may never be attainable in some clients; therefore, it is appropriate to termin... | professional practice and ethics |
31 | Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine | Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wron... | Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-... |
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obta... | Which response would help Leah regulate her emotions while accepting her situation? | Explain that feeling anxious is unhelpful if she cannot change anything. | Remind her of her counseling skills and challenge her to use them. | Validate her feelings and acknowledge her virtues as a mother. | Deliver a list of possible solutions to her problems. | (A): Explain that feeling anxious is unhelpful if she cannot change anything.
(B): Remind her of her counseling skills and challenge her to use them.
(C): Validate her feelings and acknowledge her virtues as a mother.
(D): Deliver a list of possible solutions to her problems. | Validate her feelings and acknowledge her virtues as a mother. | C | Regardless of Leah's knowledge and competency as a clinician, she is in the vulnerable position of needing to feel supported just like any other clients in your caseload. Therefore, using the same strategies as you would with a client who does not already possess prior knowledge of anxiety reduction skills will offer t... | counseling skills and interventions |
32 | Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachme... | Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions tha... | You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being remov... | At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home ... | The court provides a subpoena for an update on the counseling process. All of the following are appropriate considerations EXCEPT: | Providing all progress notes and assessments | Only sending information in an encrypted and secure manner | Providing only relevant material | Obtaining legal counsel | (A): Providing all progress notes and assessments
(B): Only sending information in an encrypted and secure manner
(C): Providing only relevant material
(D): Obtaining legal counsel | Providing all progress notes and assessments | A | Even when information is subpoenaed, it is important to only provide relevant information, which means that you may not provide the client’s entire file. The ACA Code of Ethics encourages only sharing information that is relevant to the entity receiving the information (ACA Governing Council, 2014). It may be helpful t... | professional practice and ethics |
33 | Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Di... | Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors | You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple st... | The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only co... | Based on John and Julie Gottman’s concept of the four horsemen of the apocalypse, which include criticism, defensiveness, contempt, and stonewalling, which one of the following terms describes the husband’s communication style when he disengages from the session? | Criticism | Contempt | Defensiveness | Stonewalling | (A): Criticism
(B): Contempt
(C): Defensiveness
(D): Stonewalling | Stonewalling | D | The husband’s response is an example of stonewalling. Stonewalling occurs when a partner stops engaging in communication. Criticism involves attacking the partner for who they are and what they do. Contempt involves treating the partner with disrespect and ridicule. Finally, defensiveness involves making excuses for be... | counseling skills and interventions |
34 | Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20) | Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. ... | You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal... | During the previous session, the client committed to controlled drinking and agreed on a limit of two drinks per night. She admits to having limited success with this goal and concedes to over-indulging when feeling “stressed out.” You learn she ran into a woman from her church who she discovered was a recovering alcoh... | According to the Transtheoretical Stages of Change model, in which stage would you classify this client? | Precontemplation | Action | Preparation | Contemplation | (A): Precontemplation
(B): Action
(C): Preparation
(D): Contemplation | Preparation | C | The Transtheoretical Stages of Change (SOC) Model, developed by Miller & Rollnick (2013), outlines the following SOC: precontemplation, contemplation, preparation, action, and maintenance. This client has just entered the preparation stage. Individuals in the preparation stage consider making a change but are unsure ex... | intake, assessment, and diagnosis |
35 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family | Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suici... | Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
You are an intern providing mental health counseling... | Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not t... | What approach should you recommend Shania use with Malia for discipline? | Use preventative, supportive, and corrective discipline. | Set strict boundaries with consequences. | Use positive parenting approach. | You should learn more about and meet Malia prior to making suggestions. | (A): Use preventative, supportive, and corrective discipline.
(B): Set strict boundaries with consequences.
(C): Use positive parenting approach.
(D): You should learn more about and meet Malia prior to making suggestions. | You should learn more about and meet Malia prior to making suggestions. | D | It is best practice whenever possible to obtain as much information about a client's parenting experience and their children before offering suggestions of methods to apply. Conducting skills tests, hearing family history, understanding the child's medical or psychological conditions, observing the parent-child interac... | intake, assessment, and diagnosis |
36 | Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed | Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word res... | You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and... | The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters... | After your discussion with the client about her social media use, she sends you a Facebook friend request. What is your ethical obligation regarding the use of social media, distance counseling, and other related technology? | To have written procedures in place and reviewed before or during the client’s initial session | To recognize the potential harm and benefits of developing an informal virtual relationship with clients, former clients, and their families and personal friends | To disclose that you maintain a professional and personal online presence, and it may be difficult for the client to distinguish between the two | To include in the client’s record all electronic communication, except clerical information (e.g., appointment scheduling) | (A): To have written procedures in place and reviewed before or during the client’s initial session
(B): To recognize the potential harm and benefits of developing an informal virtual relationship with clients, former clients, and their families and personal friends
(C): To disclose that you maintain a professional and... | To have written procedures in place and reviewed before or during the client’s initial session | A | Your ethical obligation is to have written procedures in place and reviewed before or during the client’s initial session. Answer B is incorrect. According to the NBCC Code of Ethics (2016), “NCCs shall include all electronic communications exchanged with clients and supervisees, including those through digital technol... | professional practice and ethics |
37 | Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual | The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former onc... | You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ag... | Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic i... | When assessing this client's cultural identity, which of the following will provide the most information? | Influence of client's cancer on her mental health | Influence of client's race, ethnicity, and sexuality on her mental health | All of the above | Influence of parent's divorce on her mental health | (A): Influence of client's cancer on her mental health
(B): Influence of client's race, ethnicity, and sexuality on her mental health
(C): All of the above
(D): Influence of parent's divorce on her mental health | All of the above | C | Culture encompasses all groups which an individual has membership in, including race, ethnicity, socioeconomics, sexuality, religion, biological disease or emotional disorder, and family of origin. For example, research shows that people who grow up in divorced households have different experiences than those in non-di... | intake, assessment, and diagnosis |
38 | Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family | Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suici... | Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
You are an intern providing mental health counseling... | Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not t... | You discuss with Shania how trauma is a psychological injury that continues to harm one's cognitive and emotional state, often rendering them helpless to recurrent patterns of maladaptive behaviors. She agrees to begin trauma work. In what order would you attempt the following interventions? | coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback | cognitive therapy, teach coping skills, EMDR | neurofeedback, prolonged exposure therapy, cognitive therapy, teach coping skills | EMDR, teach self-soothing techniques, TF-cognitive therapy | (A): coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback
(B): cognitive therapy, teach coping skills, EMDR
(C): neurofeedback, prolonged exposure therapy, cognitive therapy, teach coping skills
(D): EMDR, teach self-soothing techniques, TF-cognitive therapy | coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback | A | It is crucial that prior to having a client address their trauma they learn to master coping skills, both during exercises in session as well as at home in real life situations. Concurrent to teaching coping (self-soothing techniques included) you should engage your client in cognitive interventions, such as Cognitive ... | treatment planning |
39 | 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 ... | 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... | 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 feeli... | You learn that the client withheld information during the intake interview because of a negative experience with psychiatric treatment. Two years previously, the client presented at the emergency room with symptoms of depression and suicidal ideation. The emergency department clinician recommended hospitalization, and ... | After disclosing his experience with hospitalization, the client asks questions about your credentials, counseling approach, and experience. What would be your first response? | Understand and validate the client’s experience with hospitalization and consider contextualized factors. | Shift the focus back to the client and emphasize the importance of honest communication regarding suicidality. | Obtain a signed release of information to communicate with the hospital and request the client’s records. | Provide a written copy of informed consent, which includes your credentials and related information. | (A): Understand and validate the client’s experience with hospitalization and consider contextualized factors.
(B): Shift the focus back to the client and emphasize the importance of honest communication regarding suicidality.
(C): Obtain a signed release of information to communicate with the hospital and request the ... | Understand and validate the client’s experience with hospitalization and consider contextualized factors. | A | You would first seek to better understand and validate the client’s experiences with psychiatric care and consider contextualized factors (eg, race, gender, ethnicity). For example, researchers suggest that African Americans are more likely to be diagnosed with schizophrenia or psychosis than non-Hispanic whites presen... | counseling skills and interventions |
40 | Initial Intake: Age: 23 Gender: Male Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his e... | Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back... | Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his prob... | Shawn expresses his frustrations over his parents' pressure on him to do something with his life. Which response is the most effective use of motivational interviewing? | "I think their pressure is what is causing your social anxiety. Does that make sense?" | "I would be frustrated, too! What do you think is the best way to get them to stop?" | "You have quite the inner strength to manage that and still stay sober. How are you doing it?" | "Tell me about how your family's strong Indian culture affects you and your stress." | (A): "I think their pressure is what is causing your social anxiety. Does that make sense?"
(B): "I would be frustrated, too! What do you think is the best way to get them to stop?"
(C): "You have quite the inner strength to manage that and still stay sober. How are you doing it?"
(D): "Tell me about how your family's ... | "You have quite the inner strength to manage that and still stay sober. How are you doing it?" | C | Bringing up culture when the client did not address his culture as a stressor is not culturally sensitive, so it does not yet apply here unless Shawn chooses to discuss it. If Shawn knew the best way to "get his parents to stop pressuring him" he would not be in counseling asking you about it, nor would he feel frustra... | counseling skills and interventions |
41 | Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location o... | The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, "even though there is nothing to be angry about." You do not observe any... | First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session t... | null | What therapeutic approach would be most beneficial for this client at this time? | Adlerian therapy | Cognitive-behavioral therapy | Person-centered therapy | Emotion-focused therapy | (A): Adlerian therapy
(B): Cognitive-behavioral therapy
(C): Person-centered therapy
(D): Emotion-focused therapy | Emotion-focused therapy | D | Emotion-focused therapy (EFT) is a therapeutic approach based on the premise that emotions are key to identity. According to EFT, emotions are also a guide for individual choice and decision making. This type of therapy assumes that lacking emotional awareness or avoiding unpleasant emotions can cause harm. Therefore, ... | counseling skills and interventions |
42 | Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosex... | The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and... | First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consul... | The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers mi... | Knowing this client's history and symptomology, it would be important to assess for which disorder in the intake session? | Substance/medication-induced Obsessive-Compulsive Disorder | Attention-Deficit/Hyperactive Disorder | Somatic Symptom Disorder | Post-traumatic stress disorder (PTSD) | (A): Substance/medication-induced Obsessive-Compulsive Disorder
(B): Attention-Deficit/Hyperactive Disorder
(C): Somatic Symptom Disorder
(D): Post-traumatic stress disorder (PTSD) | Post-traumatic stress disorder (PTSD) | D | This client's combat experience and symptomology would require a PTSD rule-out to ensure that this diagnosis is not warranted. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
43 | Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate | Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. S... | You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. ... | The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. Yo... | You are using self-monitoring to obtain baseline data and wish to use the SMART framework for constructing treatment plan goals and objectives. Which of the following accurately depicts the five SMART criteria? | Strengths-based, measurable, appropriate, rational, timeless | Strengths-based, measurable, appropriate, rational, and timely | Specific, measurable, achievable, realistic, and timeless | Specific, measurable, achievable, realistic, and timely | (A): Strengths-based, measurable, appropriate, rational, timeless
(B): Strengths-based, measurable, appropriate, rational, and timely
(C): Specific, measurable, achievable, realistic, and timeless
(D): Specific, measurable, achievable, realistic, and timely | Specific, measurable, achievable, realistic, and timely | D | SMART goals and objectives are specific, measurable, achievable, realistic, and timely. The counselor and the client construct specific goals and objectives by determining, in detail, what they would like to accomplish. Measurable goals consist of changes that are observable or quantifiable in terms of progress made wi... | treatment planning |
44 | Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual ... | The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, "It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would r... | First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the "doctors are missing something" for years. She "feels sick all the time" but cannot describe specific symptoms o... | The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep ... | What cognitive error is the client making when she talks about being judged at work? | Catastrophizing | Mind reading | All-or-nothing thinking | Magnification of negative thoughts/minimizing positive ones | (A): Catastrophizing
(B): Mind reading
(C): All-or-nothing thinking
(D): Magnification of negative thoughts/minimizing positive ones | Mind reading | B | The client is demonstrating the cognitive distortion of mind reading in this session, where she assumes that others are judging her and thinking negatively about her weight without any evidence or confirmation from them. Therefore, the correct answer is (A) | counseling skills and interventions |
45 | Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Loca... | The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and... | First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult... | The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client repo... | The client asks you if you can "fix" her. What is the best response to this statement? | Acknowledge her comment, then redirect her concern | Explain the benefits of psychotherapy | Explain your role as a therapist | Convey that it may take some time, but you will work on fixing her | (A): Acknowledge her comment, then redirect her concern
(B): Explain the benefits of psychotherapy
(C): Explain your role as a therapist
(D): Convey that it may take some time, but you will work on fixing her | Explain your role as a therapist | C | Therapists, or psychotherapists, are licensed mental health professionals who specialize in helping clients develop better cognitive and emotional skills, reduce symptoms of mental illness, and cope with various challenges to improve their lives. Therefore, the correct answer is (A) | professional practice and ethics |
46 | 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 anyo... | 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 see... | null | Later in the day, the counselor realized what had occurred in his office and went to find Autumn in class. The counselor explained that the other school counselor had left some of her files on her desk of graduated students college essays. The counselor stated that regardless of this, all files should have been put awa... | Non-judgement | Genuineness | Congruence | Positive regard | (A): Non-judgement
(B): Genuineness
(C): Congruence
(D): Positive regard | Genuineness | B | In this situation, the counselor is displaying the attribute of genuineness as she is speaking honestly and apologizing for her mistake without being defensive or pretentious. Congruence is when a counselor gives feedback on the client's progress in a genuine manner. Positive regard describes when a counselor can focus... | intake, assessment, and diagnosis |
47 | Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10) | Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesi... | You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somew... | History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was la... | To accurately diagnose social anxiety disorder, individuals must experience marked fear or anxiety in social situations and which of the following? | Fear of acting in ways that other people will scrutinize | Fear of social situations because of perceived appearance-related flaws | Fear of not being able to escape certain situations in the presence of profound anxiety | Fear of being incapacitated by an unforeseen panic attack in public | (A): Fear of acting in ways that other people will scrutinize
(B): Fear of social situations because of perceived appearance-related flaws
(C): Fear of not being able to escape certain situations in the presence of profound anxiety
(D): Fear of being incapacitated by an unforeseen panic attack in public | Fear of acting in ways that other people will scrutinize | A | According to the DSM-5-TR, social anxiety disorder is characterized by a marked and persistent fear of social situations or occasions in which the individual may be called upon to perform. Typically, the individual fears criticism and evaluation by others. This aspect of social anxiety disorder differentiates it from o... | counseling skills and interventions |
48 | Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosex... | The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and... | First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consul... | The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers mi... | The client expresses concern about his daughter's difficulties at school and inquires about the possibility of you becoming her therapist. Which of the following responses would be most appropriate to the client's request? | Explain the potential for a conflict of interest and offer to provide a referral for his daughter. | Clarify that offering therapy to adolescents falls outside the scope of your clinical practice. | Consent to become the therapist for his daughter and elucidate that she will receive exceptional care. | Explain that you cannot work with both of them in your practice as it would be a violation of ethical principles. | (A): Explain the potential for a conflict of interest and offer to provide a referral for his daughter.
(B): Clarify that offering therapy to adolescents falls outside the scope of your clinical practice.
(C): Consent to become the therapist for his daughter and elucidate that she will receive exceptional care.
(D): Ex... | Explain the potential for a conflict of interest and offer to provide a referral for his daughter. | A | This response acknowledges the potential conflicts of interest and suggests that it would be best for the client's daughter to receive treatment from another counselor. Therefore, the correct answer is (C) | counseling skills and interventions |
49 | Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual | Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin. | Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling ... | null | The severity of Mark's symptoms can be assessed by administering all of the following, except? | Calgary Depression Scale for Schizophrenia | Brief Psychiatric Rating Scale (BPRS) | The scale of assessment for Positive symptoms (SAPS) | The scale for the assessment of Negative symptoms (SANS) | (A): Calgary Depression Scale for Schizophrenia
(B): Brief Psychiatric Rating Scale (BPRS)
(C): The scale of assessment for Positive symptoms (SAPS)
(D): The scale for the assessment of Negative symptoms (SANS) | Calgary Depression Scale for Schizophrenia | A | The Calgary depression scale for schizophrenia should not be used as Mark did not mention any symptoms of depression. The SANS measures 25 negative symptoms of schizophrenia including lack of facial expressions, social inattentiveness, lack of interests and relationships. SAPS checks for 34 positive symptoms including ... | intake, assessment, and diagnosis |
50 | Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate | Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day beca... | You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents ... | The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him... | You have selected acceptance and commitment therapy (ACT) and mindfulness to best address which of the following? | Shame and guilt | Sexual desire | Social isolation | Negative self-talk | (A): Shame and guilt
(B): Sexual desire
(C): Social isolation
(D): Negative self-talk | Shame and guilt | A | Acceptance and commitment therapy and mindfulness are evidence-based mental health interventions for various mental health disorders, including depression. The premise of ACT is that moving individuals toward acknowledging and accepting (rather than fighting) their thoughts and feelings in the present moment influence ... | counseling skills and interventions |
51 | Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual ... | The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client... | First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks do... | The client's father died when she was very young. She describes her mother as having a "difficult time raising me and my brother as a single mother." The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted l... | How would you use dialectical behavior therapy to validate the client's positive experiences in this relationship and help her manage any potential risks? | Acknowledge her feelings and encourage the client to continue her current treatment plan and discuss her new relationship during her next session. | Acknowledge her feelings, and challenge the client's perception of her new relationship, focusing on the potential negative consequences of her impulsive actions. | Acknowledge her feelings and encourage her to take the relationship slowly while continuing to get to know her partner. | Acknowledge her feelings and encourage her to recognize and act on the positive effects of the relationship. | (A): Acknowledge her feelings and encourage the client to continue her current treatment plan and discuss her new relationship during her next session.
(B): Acknowledge her feelings, and challenge the client's perception of her new relationship, focusing on the potential negative consequences of her impulsive actions.
... | Acknowledge her feelings and encourage her to take the relationship slowly while continuing to get to know her partner. | C | Validation is an important part of creating a supportive and safe therapeutic environment. By validating her positive experiences in this relationship, it can help to reinforce and build the client's feelings of self worth and trust in herself. Additionally, by encouraging her to take things slowly while continuing to ... | counseling skills and interventions |
52 | Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therap... | The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye co... | First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that y... | The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to ... | What is a common reason that couples therapy fails? | Couples' communication styles are overtly ambiguous. | The couple lacks the willingness to deal with uncomfortable feelings. | The couple lacks the ability to see their relationship and themselves objectively. | The couple does not seek therapy until problems are severe. | (A): Couples' communication styles are overtly ambiguous.
(B): The couple lacks the willingness to deal with uncomfortable feelings.
(C): The couple lacks the ability to see their relationship and themselves objectively.
(D): The couple does not seek therapy until problems are severe. | The couple does not seek therapy until problems are severe. | D | Most couples do not go to therapy until their problems have escalated out of control, which often results in unsuccessful therapy. Therefore, the correct answer is (C) | counseling skills and interventions |
53 | Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual | John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on sit... | Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he wil... | Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchi... | Before wrapping up your latest session, you suggest John attend a support group. Which of the following is not the best recommendation? | Celebrate Recovery | Emotions Anonymous | A support group for single professionals | A men's divorce support group | (A): Celebrate Recovery
(B): Emotions Anonymous
(C): A support group for single professionals
(D): A men's divorce support group | A support group for single professionals | C | This type of group may trigger John and not adequately address his emotional needs. Emotions Anonymous is a 12-step group for dealing with any emotional condition. Celebrate Recovery is also a 12-step group that is faith-based and addresses recovery from any addiction, "hurt, habit or hang-up" and can be a new outlet f... | counseling skills and interventions |
54 | Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate | Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day beca... | You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents ... | ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents ... | What information gathered during the assessment is most indicative of the diagnosis of Major Depressive Disorder (MDD)? | Poor coping skills | Strained relationships with family members | Emotional dysregulation | Excessive guilt | (A): Poor coping skills
(B): Strained relationships with family members
(C): Emotional dysregulation
(D): Excessive guilt | Excessive guilt | D | The client’s diagnosis of Major Depressive disorder is confirmed by the following symptoms: excessive guilt, suicidal ideation, insomnia, persistent negative mood, and feelings of worthlessness. These symptoms must be present during a sustained period of 2 weeks, which is also confirmed in the assessment. Strained rela... | intake, assessment, and diagnosis |
55 | Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Ther... | Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesita... | First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the "latest incident at school," wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself... | The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his t... | Which instrument would allow you to screen for Autism Spectrum Disorder? | Behavior Assessment Rating Scale | The Behaviors and Experiences Inventory | The Behavior Assessment System for Children | The Behavioral Summarized Evaluation | (A): Behavior Assessment Rating Scale
(B): The Behaviors and Experiences Inventory
(C): The Behavior Assessment System for Children
(D): The Behavioral Summarized Evaluation | The Behavioral Summarized Evaluation | D | The Behavioral Summarized Evaluation assesses Autism Spectrum Disorders. Therefore, the correct answer is (A) | intake, assessment, and diagnosis |
56 | Initial Intake: Age: 23 Gender: Male Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his e... | Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back... | Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his prob... | Before hanging up with Shawn's parents over the phone, you tell them "I am very impressed with and grateful for your concern and involvement in Shawn's healing process, so I thank you for understanding that he is not yet ready to share in front of his parents!" This statement best demonstrates which attribute? | Sensitivity to multicultural issues | Respect for client confidentiality | Awareness of self and impact on clients | Empathic attunement | (A): Sensitivity to multicultural issues
(B): Respect for client confidentiality
(C): Awareness of self and impact on clients
(D): Empathic attunement | Respect for client confidentiality | B | Using this positive voice in an uncomfortable situation where the payors of your client's counseling are demanding to sit in your sessions is an effective method for demonstrating respect of your client's HIPAA rights. Answers a, c and d do not seem to apply here; although it is important to be aware of self and the im... | counseling skills and interventions |
57 | Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual | Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself do... | Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university... | Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling a... | Jonny responds to your outburst by grabbing his books and leaving your office. You feel powerfully obliged to run after him and apologize. What should you do? | Go apologize right away and ask him if he will come back in and talk. | Let the dust settle and process with Jonny at your next scheduled session. | Call his cell phone and leave a voicemail asking about his safety. | Allow him to go and then consult with a supervisor prior to engaging Jonny again. | (A): Go apologize right away and ask him if he will come back in and talk.
(B): Let the dust settle and process with Jonny at your next scheduled session.
(C): Call his cell phone and leave a voicemail asking about his safety.
(D): Allow him to go and then consult with a supervisor prior to engaging Jonny again. | Allow him to go and then consult with a supervisor prior to engaging Jonny again. | D | There has clearly been a breach of trust in your therapeutic relationship with Jonny considering his reaction. Seeking supervision to process your thoughts and feelings, choices you have made, and underlying reasons why is the best choice for you. It is vital that counselors have good self-awareness and understand how ... | counseling skills and interventions |
58 | Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10) | Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesi... | You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somew... | The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview afte... | The client recognizes gains that she has made but fears that she will fail after discharge. Which humanistic technique would you use to best respond to this discrepancy? | Self-disclosure | Constructive confrontation | Amplified reflection | Attending | (A): Self-disclosure
(B): Constructive confrontation
(C): Amplified reflection
(D): Attending | Constructive confrontation | B | Constructive confrontation is designed to help clients achieve congruence. Humanistic therapists assert that incongruence occurs when there is a discrepancy between clients’ perceptions of themselves and reality. Therapists use constructive confrontation when pointing out discrepancies among the client’s actions, thoug... | counseling skills and interventions |
59 | 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: ... | 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 hi... | 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 ref... | 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 thr... | The client is in the early stages of recovery and has stated that he and his wife want to work on their relationship. How would you incorporate this request into his treatment plan? | Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time. | Provide the client the option to start couples therapy now or after his recovery. | Recognize that couples' therapy is appropriate only after his rehabilitation is complete, and advise against it. | Let the client determine what he wants to do about the couples therapy. | (A): Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time.
(B): Provide the client the option to start couples therapy now or after his recovery.
(C): Recognize that couples' therapy is appropriate only after his rehabilitation is complete, and advise against it.
(D): ... | Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time. | A | As early on as the client's recovery appears to be, beginning couples therapy at this time would be premature. Allowing him to get stabilized initially will be essential before diving into the relationship dynamics. It would be okay to convey that you could be available for follow-up couples work if necessary when the ... | treatment planning |
60 | Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Loca... | The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and... | First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult... | The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client repo... | Which of the following assessments would you use during the diagnostic interview to identify mental health domains which may have a significant impact on the client? | Personal History Questionnaire | Cultural Formulation Interview | Family genogram | Level 1 Cross-Cutting Symptom Measure | (A): Personal History Questionnaire
(B): Cultural Formulation Interview
(C): Family genogram
(D): Level 1 Cross-Cutting Symptom Measure | Level 1 Cross-Cutting Symptom Measure | D | The DSM-5-TR Level 1 Cross-Cutting Symptom Measure is a self- or informant-rated measure which assesses mental health domains important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry which may significantly impact the individual's treatment and prognosis. Therefore,... | intake, assessment, and diagnosis |
61 | 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 : Commun... | 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 ... | 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... | 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 ... | Which tool would provide the most comprehensive information about Rick before entering group therapy? | Thematic Apperception Test (TAT) | Millon Clinical Multiaxial Inventory (MCMI-III) | Columbia Impairment Scale (CIS) | BRIGANCE Comprehensive Inventory of Basic Skills (CIBS) | (A): Thematic Apperception Test (TAT)
(B): Millon Clinical Multiaxial Inventory (MCMI-III)
(C): Columbia Impairment Scale (CIS)
(D): BRIGANCE Comprehensive Inventory of Basic Skills (CIBS) | Millon Clinical Multiaxial Inventory (MCMI-III) | B | The MCMI-III is used to assess for a wide range of psychological disorders and syndromes, including anxiety, depression, bipolar disorder, substance abuse, and other personality disorders. The MCMI-III consists of 175 multiple-choice questions that assess a person's current psychological functioning. Therefore, the cor... | intake, assessment, and diagnosis |
62 | Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder... | Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client w... | You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagno... | This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client ... | After the session, you provide psychoeducation to the parents regarding how to support their son in coping with the denial of his request to have a block put in a certain place. Based on your short-term goals with the client, all of the following would be appropriate interventions, EXCEPT: | Instruct the client on anger management skills. | Remind the client that others have different ways of playing and that is okay. | Prompt the client to practice deep breathing. | Support the client to learn progressive muscle relaxation. | (A): Instruct the client on anger management skills.
(B): Remind the client that others have different ways of playing and that is okay.
(C): Prompt the client to practice deep breathing.
(D): Support the client to learn progressive muscle relaxation. | Remind the client that others have different ways of playing and that is okay. | B | You compiled goals for the client in the first session based on the ASD diagnosis, and you identified the client’s difficulty with imaginative play. This barrier would make understanding that others have different ways of playing difficult for the client and would be the least appropriate intervention in this scenario.... | treatment planning |
63 | 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: ... | 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 hi... | 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 ref... | 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 thr... | How would you proceed with the client as he presents for this therapy session in his current state? | Empathize with the client, and utilize the situation to attempt to establish rapport. | Be direct and reschedule the appointment. | Consider this session a 'non-event', since the client was too impaired for him to have been competent to give consent. | Explore with the client what was happening before the session that led to his coming to the session intoxicated. | (A): Empathize with the client, and utilize the situation to attempt to establish rapport.
(B): Be direct and reschedule the appointment.
(C): Consider this session a 'non-event', since the client was too impaired for him to have been competent to give consent.
(D): Explore with the client what was happening before the... | Be direct and reschedule the appointment. | B | It is critical to set limits with clients in general, especially in setting standards for managing substance use issues. Being under the influence while attending therapy is not clinically appropriate nor professionally acceptable. Therefore, the correct answer is (A) | counseling skills and interventions |
64 | Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birt... | The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His moo... | First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distract... | The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource r... | Based on your observations of the client in session, what might you do to build a therapeutic alliance with him? | Bring a two-person video game to play with the client. | Speak in a clear and authoritative voice to the child and request that he respond | Use therapeutic silence until the client responds | Ask the child if he would like to examine the clock on your desk | (A): Bring a two-person video game to play with the client.
(B): Speak in a clear and authoritative voice to the child and request that he respond
(C): Use therapeutic silence until the client responds
(D): Ask the child if he would like to examine the clock on your desk | Ask the child if he would like to examine the clock on your desk | D | This may help the child gain trust and form a therapeutic alliance with you. Recall that while he was hiding behind his mother during the session, he appeared to be interested in the clock on your desk. Therefore, the correct answer is (D) | counseling skills and interventions |
65 | Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0) | Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f | You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currentl... | Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and une... | Which of the following would be a helpful career aptitude tool for a client with limited resources? | O*Net Interest Profiler | Motivational Appraisal Personal Potential | Criteria Cognitive Aptitude Test | Career Assessment Inventory | (A): O*Net Interest Profiler
(B): Motivational Appraisal Personal Potential
(C): Criteria Cognitive Aptitude Test
(D): Career Assessment Inventory | O*Net Interest Profiler | A | The O*Net Interest Profiler is a free online tool that is used to determine what abilities can lead to careers that match an individual’s existing skills and abilities. The Motivational Appraisal Personal Potential, Career Assessment Inventory, and Criteria Cognitive Aptitude Test are all clinical counseling assessment... | professional practice and ethics |
66 | Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gende... | The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal i... | First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, ofte... | The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accide... | Given the client's physical condition, what should you do first? | Determine the client's blood alcohol content (BAC) for proper notation. | Establish boundaries regarding therapy and being intoxicated | Reschedule the session and address your concerns at that time | Refer the client to a residential program | (A): Determine the client's blood alcohol content (BAC) for proper notation.
(B): Establish boundaries regarding therapy and being intoxicated
(C): Reschedule the session and address your concerns at that time
(D): Refer the client to a residential program | Establish boundaries regarding therapy and being intoxicated | B | Taking advantage of a difficult situation could facilitate possible changes needed in the client by implementing motivational interviewing techniques while at the same time being able to be firm with the client to reinforce what is minimally expected as part of the therapeutic experience would be helpful. Therefore, th... | professional practice and ethics |
67 | Initial Intake: Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual | Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
| Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.
History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his tea... | null | Symptoms indicate the possibility of? | Post-Traumatic Stress Disorder and Major Depressive Disorder | Post-traumatic Stress Disorder and Dissociative Amnesia | Adjustment Disorder and Dissociative Amnesia | Post-Traumatic Stress Disorder and Traumatic Brain Injury | (A): Post-Traumatic Stress Disorder and Major Depressive Disorder
(B): Post-traumatic Stress Disorder and Dissociative Amnesia
(C): Adjustment Disorder and Dissociative Amnesia
(D): Post-Traumatic Stress Disorder and Traumatic Brain Injury | Post-Traumatic Stress Disorder and Traumatic Brain Injury | D | Carl's symptoms -- avoidance, guilt, distressing dreams, reckless and self-destructive behaviors -- have caused significant distress and impairment, indicate Post Traumatic Stress Disorder. He lost consciousness for half a day after the blast and could not remember who he was for two days. According to his medical reco... | counseling skills and interventions |
68 | Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Loca... | The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and... | First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult... | The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client repo... | Which of the following is not a benefit of reviewing the client's progress in treatment? | It helps you determine whether treatment goals are being met. | It allows you to assess your therapy effectiveness. | It helps you to uncover the client's motivation for seeking therapy. | It enables you to reevaluate the client's needs. | (A): It helps you determine whether treatment goals are being met.
(B): It allows you to assess your therapy effectiveness.
(C): It helps you to uncover the client's motivation for seeking therapy.
(D): It enables you to reevaluate the client's needs. | It helps you to uncover the client's motivation for seeking therapy. | C | Uncovering a client's motivation for seeking therapy happens at intake when she expresses her concerns. Assessing mental health is a process, not a one-time event. It is important, therefore, to monitor a person's mental health symptoms throughout treatment as they may change over time. Therefore, the correct answer is... | treatment planning |
69 | Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in spe... | You are a counselor in a private practice setting. During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional... | Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician presc... | Which of the following assessments would be used next in most effectively understanding your client's substance use? | Drug and Alcohol Screening (DAS) | Drug Abuse Screening Test (DAST) | Alcohol Use Disorders Identification Test (AUDIT) | Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) | (A): Drug and Alcohol Screening (DAS)
(B): Drug Abuse Screening Test (DAST)
(C): Alcohol Use Disorders Identification Test (AUDIT)
(D): Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) | Drug Abuse Screening Test (DAST) | B | The DAST is a drug screening tool that does not include screening for alcohol. Since the MAST has already screened for alcohol use, it is important to screen for other substances. The MMPI-2 is a good instrument but is broader and more expensive than needed for substance screening. The AUDIT assesses alcohol use so dup... | intake, assessment, and diagnosis |
70 | Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location... | The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and mainta... | First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as "Christine," although the father says "Christopher" each tim... | The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels... | "Gender identity" refers to which of the following? | An individual's identification as male, female, or another category | A broad spectrum of individuals who transiently or persistently identify as a gender different than their natal gender. | The identification of a person based on physical characteristics, such as reproductive organs. | The initial assignment as male or female which occurs at birth | (A): An individual's identification as male, female, or another category
(B): A broad spectrum of individuals who transiently or persistently identify as a gender different than their natal gender.
(C): The identification of a person based on physical characteristics, such as reproductive organs.
(D): The initial assig... | An individual's identification as male, female, or another category | A | Gender is used to denote the publicly lived roles of an individual, and identity is how an individual lives. Therefore, the correct answer is (B) | intake, assessment, and diagnosis |
71 | Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of ... | The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, "I guess; I don't know." | First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confus... | The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being "understood" by his parents. He withdraws... | What intervention would be most beneficial for the parents and client to address his behavior disturbances? | The family is not your client; interventions should be client-specific. | A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal | Setting up a positive reward system in the house for good behavior (an "if/then" chart for the client) and giving a list to the parents of appropriate restrictions for the client | Discuss various disciplinary actions and their effectiveness with the parents, and instruct them on what is going to work best for the client | (A): The family is not your client; interventions should be client-specific.
(B): A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal
(C): Setting up a positive reward system in the house for good behavior (an "if/then" chart for the client) and giving a list... | A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal | B | These options are age-appropriate and are helpful to the client to engage in self-awareness and self-confidence building. Therefore, the correct answer is (D) | counseling skills and interventions |
72 | 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 : Commun... | 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 ... | 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... | 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 ... | As the group leader, which technique would you use to build cohesion and encourage group members to work together? | Modeling | Linking | Active listening | Unconditional Positive Regard | (A): Modeling
(B): Linking
(C): Active listening
(D): Unconditional Positive Regard | Linking | B | In group therapy, linking involves the group leader compares members to each other based on what is shared. Finding commonalities encourages group members to work together. Therefore, the correct answer is (C) | counseling skills and interventions |
73 | Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with ... | Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date o... | You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the clien... | ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career w... | You are a certified counselor who has never worked with a client diagnosed with MND. You assess your ability to work with this client based on your credentials and the information provided thus far. At this point in treatment, which of the following statements is the most accurate? | You should refer the client to a counselor who specializes in neurocognitive disorders. | You should proceed with the client only after obtaining specialized training and consultation. | You should proceed with the client unless the results of the PET scan indicate advanced memory impairment. | Your background and training should permit you to work with this client. | (A): You should refer the client to a counselor who specializes in neurocognitive disorders.
(B): You should proceed with the client only after obtaining specialized training and consultation.
(C): You should proceed with the client unless the results of the PET scan indicate advanced memory impairment.
(D): Your backg... | Your background and training should permit you to work with this client. | D | Despite never working with a client diagnosed with MND, your education, experience, and training should provide you with the skills to treat the client’s anxiety, apathy, and depression. You can provide supportive counseling, address psychosocial symptoms, teach coping skills, and suggest compensatory memory strategies... | professional practice and ethics |
74 | Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Ther... | The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat qu... | First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She ha... | The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adh... | Given the client is resistant to actively participating in therapy and primarily seeks validation that she has attended sessions, how would you navigate this situation to foster genuine engagement while addressing her underlying motives and considering ethical implications? | Indicate that you will only report to her probation officer if she actively engages in the therapeutic process. | Begin the session, ignoring her resistance, and proceed with the therapy | Explain that treatment goals are predefined for mandated clients and are determined by the court jurisdiction | Engage in motivational interviewing | (A): Indicate that you will only report to her probation officer if she actively engages in the therapeutic process.
(B): Begin the session, ignoring her resistance, and proceed with the therapy
(C): Explain that treatment goals are predefined for mandated clients and are determined by the court jurisdiction
(D): Engag... | Engage in motivational interviewing | D | Motivational interviewing would be a good way to engage the client in the therapeutic process given that she has been court-ordered and is not happy about being in therapy. Therefore, the correct answer is (B) | counseling skills and interventions |
75 | Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : ... | The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, ... | First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. Th... | The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended... | Which would be most beneficial to communicate in your last session with the client? | "You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward." | "Are there any other specific questions or concerns you would like to address at this moment?" | "It is important to prioritize self-care and not feel pressured to prioritize forming friendships, as you can be content and fulfilled on your own." | "You did an incredible job and I wish you the best going forward." | (A): "You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward."
(B): "Are there any other specific questions or concerns you would like to address at this moment?"
(C): "It is important to prioritize self-care and not feel pressured to prioritize forming friends... | "You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward." | A | The idea is to put both the past and the future into a positive perspective moving ahead for this client. You are also reinforcing his capacity to discover new ways of responding to difficulties in life and preparing at the same time for the future. Therefore, the correct answer is (B) | counseling skills and interventions |
76 | 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 wi... | 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... | The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fa... | You do not share the same religious views as the client. Which of the following would be the most helpful approach when considering the impact of your own beliefs in counseling? | You support the client’s beliefs and do not impose your own values | You encourage the client to assess his own beliefs and if he really does believe them because he is currently feeling that they are incongruent with those of the church | You continuously assess how your beliefs may affect the counseling process | You explain to your client that you do not share his beliefs; therefore, you may not be very helpful in supporting him | (A): You support the client’s beliefs and do not impose your own values
(B): You encourage the client to assess his own beliefs and if he really does believe them because he is currently feeling that they are incongruent with those of the church
(C): You continuously assess how your beliefs may affect the counseling pr... | You continuously assess how your beliefs may affect the counseling process | C | It would be most helpful to continuously assess how your own values and beliefs affect the counseling process. Although it is important to support your client’s beliefs and not impose your own, there is a level of self-reflection that is important in the process of counseling to ensure that you are not unintentionally ... | core counseling attributes |
77 | Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual | Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she t... |
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a p... | Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lot... | Lottie uses play to show how her father was killed. She notices you have let a tear out of your eye while observing her and says, "Why are you crying? Please don't!" What is the best clinical response? | "Why not, don't you cry when you think about your dad?" | "Lottie, what you shared was sad. I cried. But I am okay." | "I just have irritated eyes, nothing to do with you." | "I'm so sorry you saw that; I couldn't hold it back." | (A): "Why not, don't you cry when you think about your dad?"
(B): "Lottie, what you shared was sad. I cried. But I am okay."
(C): "I just have irritated eyes, nothing to do with you."
(D): "I'm so sorry you saw that; I couldn't hold it back." | "Lottie, what you shared was sad. I cried. But I am okay." | B | Demonstrating to a child that a person can cry when something is sad, but that they can also be okay right afterwards, is a very powerful clinical lesson. Helping model for Lottie a healthy grief response and recovery is a great way for her to learn that she can do the same thing. Turning the response back onto her can... | counseling skills and interventions |
78 | Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual | The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one drivin... | You are a counselor in a private practice setting. During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing ... | Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due... | Considering the information gained in this session, which attachment style seems most appropriate for this client's history and current presentation? | Ambivalent attachment | Disorganized attachment | Avoidant attachment | Secure attachment | (A): Ambivalent attachment
(B): Disorganized attachment
(C): Avoidant attachment
(D): Secure attachment | Ambivalent attachment | A | Adults with parental figures who were inconsistently available and rejecting, or violated normal boundaries tend to be anxious and insecure, ruminate about relationships and may be dependent or needy. Adults with secure attachments create meaningful relationships and set healthy boundaries, those with avoidant attachme... | counseling skills and interventions |
79 | Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosex... | The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and... | First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consul... | The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers mi... | What is the primary step a therapist should take if a client is presenting in a manic state that impairs their capacity for autonomous decision-making or indicates a potential risk to others? | Respect the client's autonomy and ask how they would like to proceed. | Sit with the client until they are stable. | Call the client's spouse and arrange pickup. | Coordination of inpatient care. | (A): Respect the client's autonomy and ask how they would like to proceed.
(B): Sit with the client until they are stable.
(C): Call the client's spouse and arrange pickup.
(D): Coordination of inpatient care. | Coordination of inpatient care. | D | The therapist has an ethical duty to protect the client and community. Therefore, the correct answer is (D) | professional practice and ethics |
80 | Initial Intake: Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual | Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife. | Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.
History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and... | null | To understand Theodore in the context of his family, a systemic counselor would? | Use tools, such as a genogram, to show relationships | Teach Theodore coping mechanisms when he is frustrated with Nate | Focus on a diagnosis | Focus on Theodore's experiences since his wife's passing | (A): Use tools, such as a genogram, to show relationships
(B): Teach Theodore coping mechanisms when he is frustrated with Nate
(C): Focus on a diagnosis
(D): Focus on Theodore's experiences since his wife's passing | Use tools, such as a genogram, to show relationships | A | A systemic counselor tries to look at a client within his/her system and not just individually. One way to do this, is by using a genogram. A genogram would be particularly helpful in this situation to understand the dynamic between Theodore and Nate. A systemic counselor would not just focus on obtaining information t... | counseling skills and interventions |
81 | Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual | The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues. He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thou... | You are a counselor in a community agency setting. Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had pur... | Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client ... | Which of the following interventions would be the most effective in helping the client learn how his traits impact his relationships with himself and others? | Invite client to join a long-term process group | Invite client to bring spouse to sessions | All of the above | Invite client to read a book about narcissism | (A): Invite client to join a long-term process group
(B): Invite client to bring spouse to sessions
(C): All of the above
(D): Invite client to read a book about narcissism | All of the above | C | All of the above interventions are appropriate for a client with narcissistic traits and partial insight. Because the client recognizes his personality characteristics and wants to create changes, reading about the personality style will help him understand his defenses better and may allow him to view these as defense... | treatment planning |
82 | 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:... | 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 l... | 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 bei... | 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... | Which statement shows your support of the client in dealing with her feelings? | "What I hear you saying is that you feel like drawing helps your mood." | "What I hear you saying is that you feel better when you skip school." | "Your mother reports that you are difficult at home." | "What I hear you saying is you are feeling powerless, and you are not in control of your own life." | (A): "What I hear you saying is that you feel like drawing helps your mood."
(B): "What I hear you saying is that you feel better when you skip school."
(C): "Your mother reports that you are difficult at home."
(D): "What I hear you saying is you are feeling powerless, and you are not in control of your own life." | "What I hear you saying is you are feeling powerless, and you are not in control of your own life." | D | Mirroring the client's feelings can help the client experience a sense of understanding and rapport. Therefore, the correct answer is (D) | counseling skills and interventions |
83 | Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Loc... | The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the dis... | First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and disc... | The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had "hi... | The client and her mother have made it clear that they as a family have decided that bringing the client's baby to term and seeking adoption is the best choice for them; a direction that the client seems comfortable with. In acknowledgment of the client's intentions, but also being mindful of the difficulties that she ... | Considering that the client has now decided firmly to seek adoption for her child, you should suggest that the boyfriend might now be amenable to providing emotional support. | In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support group. | Given the client's age, lack of maturity, and still tenuous psychological condition, you should provide psychoeducation on teen pregnancy. | You should advise that the client continue to meet with her minister, since his involvement was key to gaining the parents' positive involvement, and could still be helpful in providing spiritual comfort. | (A): Considering that the client has now decided firmly to seek adoption for her child, you should suggest that the boyfriend might now be amenable to providing emotional support.
(B): In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support gr... | In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support group. | B | Attending a teen pregnancy support group would be helpful. Therefore, the correct answer is (A) | core counseling attributes |
84 | 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, ap... | 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... | 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... | Having assessed the client as ISA type, which of the following will provide the client with the best occupational information that match her type? | The Occupation Finders Handbook | The Occupational Outlook Handbook | Occupational Network Encyclopedia of Titles | The Career Options Handbook of Occupational Titles | (A): The Occupation Finders Handbook
(B): The Occupational Outlook Handbook
(C): Occupational Network Encyclopedia of Titles
(D): The Career Options Handbook of Occupational Titles | The Occupational Outlook Handbook | B | The Occupational Outlook Handbook (OOH) is published by the Bureau of Labor Statistics in the U S Department of Labor. It contains thousands of occupations and information about each that include work environment, job tasks, required training, salary and growth projections, and advancement opportunities. It is updated ... | intake, assessment, and diagnosis |
85 | 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 Modalit... | 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: T... | 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 h... | 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... | Which might you use to provide additional information about this couple? | 16 Personality Factor Questionnaire (16PF) | Myers-Briggs Type Indicator (MBTI) | Marital Satisfaction Inventory (MSI) | Sexual Interaction Inventory (SII) | (A): 16 Personality Factor Questionnaire (16PF)
(B): Myers-Briggs Type Indicator (MBTI)
(C): Marital Satisfaction Inventory (MSI)
(D): Sexual Interaction Inventory (SII) | Marital Satisfaction Inventory (MSI) | C | This is a 150-item inventory to help determine the nature and intensity of the couple's distress. Therefore, the correct answer is (D) | intake, assessment, and diagnosis |
86 | Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who... | Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia | You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the... | tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The clie... | Based on the client’s past relationships, which of the following would be helpful in understanding the client’s relationship patterns? | Clinician Administered PTSD Scale for DSM-5-TR | Relationship Assessment Scale | A genogram | Adult Attachment Interview | (A): Clinician Administered PTSD Scale for DSM-5-TR
(B): Relationship Assessment Scale
(C): A genogram
(D): Adult Attachment Interview | A genogram | C | Creating a genogram could be very helpful with this client because it examines relationships with family members and is a visual representation of these relationships including the psychological factors that affect the family and the client. This can be helpful in understanding where this client came from and how it sh... | counseling skills and interventions |
87 | 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: Indiv... | 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 ... | 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 d... | 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 cor... | What is the primary purpose of parental skills training? | To create a sense of trust between parent and child | To help parents understand their children's emotional needs | To help parents learn how to control their children's behavior | To provide parents with tools for engaging in positive parenting practices | (A): To create a sense of trust between parent and child
(B): To help parents understand their children's emotional needs
(C): To help parents learn how to control their children's behavior
(D): To provide parents with tools for engaging in positive parenting practices | To provide parents with tools for engaging in positive parenting practices | D | The primary goal of parental skills training is to provide parents with evidence-based tools and techniques for fostering healthy relationships with their children. Therefore, the correct answer is (B) | counseling skills and interventions |
88 | 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... | iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents | Which of the following would be a clinically appropriate short-term goal at this point in therapy once rapport is built? | Improve the client’s ability to follow directions from his parents. | Improve social interactions with peers and his sister. | Improve grades and functioning in school. | Improve the client’s awareness of the consequences of his actions. | (A): Improve the client’s ability to follow directions from his parents.
(B): Improve social interactions with peers and his sister.
(C): Improve grades and functioning in school.
(D): Improve the client’s awareness of the consequences of his actions. | Improve the client’s awareness of the consequences of his actions. | D | The client becoming more aware of the consequences of his actions would be an appropriate short-term goal at this point in the therapeutic relationship. This would be appropriate because it is prioritizing creating awareness more than a significant change in behavior and would assist the client in knowing what he is do... | treatment planning |
89 | Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Loc... | The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the dis... | First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and disc... | The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had "hi... | Based on the client's home life, the realities of her pregnancy, and her relationship with her parents, which would be the most beneficial short-term goal to include in a treatment plan? | The client will learn an array of emotion regulation strategies to assist her in effectively functioning with her parents in conflictual situations. | The family will learn and understand triggers and negative patterns contributing to their family problems. | The client and her parents will engage in a psychoeducational unit regarding the physiological and psychological implications of teen pregnancy. | The client and her parents will learn effective communication and conflict-resolution skills to overcome barriers to meaningful conversations. | (A): The client will learn an array of emotion regulation strategies to assist her in effectively functioning with her parents in conflictual situations.
(B): The family will learn and understand triggers and negative patterns contributing to their family problems.
(C): The client and her parents will engage in a psych... | The client and her parents will learn effective communication and conflict-resolution skills to overcome barriers to meaningful conversations. | D | This is the most beneficial short-term goal to include in her treatment plan because it highlights their presenting problems. Therefore, the correct answer is (D) | treatment planning |
90 | Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Engaged Counseling Setting: Agency - Telehealth Type of Counseling: Individual | Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and ... | Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9)
You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt... | Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resen... | Which of the following is the most helpful response for the client when she reported experiencing panic out in public? | "You did the right thing by calling your friend to help you calm down, great job!" | "There's nothing to be afraid of right now, it's likely a reaction to your past trauma." | "Always ensure you know where the nearest police officer is, your safety is paramount." | "Next time you have anxiety, remind yourself of everything you are grateful for!" | (A): "You did the right thing by calling your friend to help you calm down, great job!"
(B): "There's nothing to be afraid of right now, it's likely a reaction to your past trauma."
(C): "Always ensure you know where the nearest police officer is, your safety is paramount."
(D): "Next time you have anxiety, remind your... | "You did the right thing by calling your friend to help you calm down, great job!" | A | Using a strengths-based approach, affirming the client of what she did well is the best response. The client reached out to a safe contact requesting support in soothing her nerves; this is the next best thing to being able to soothe herself. Invalidating her experience of fear, assuring her safety where it is not felt... | counseling skills and interventions |
91 | Initial Intake: Age: 18 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual | Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated... | Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is sta... | null | Which of the following does not need immediate assessment in Nadia's case? | Mental status | Where Nadia goes when she is away | Cognitive and adaptive functioning | Parent/child relationship | (A): Mental status
(B): Where Nadia goes when she is away
(C): Cognitive and adaptive functioning
(D): Parent/child relationship | Parent/child relationship | D | Although it is important to explore Nadia's relationship with her parents, there are more immediate concerns. These include knowing where Nadia goes when she runs away, to assess for safety. It is also important to assess Nadia's cognitive and adaptive functioning since her cognitive functioning seems low. This is not ... | intake, assessment, and diagnosis |
92 | Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Thera... | The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homic... | First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and... | The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors ... | You feel the client may benefit from concurrent treatment. Who would you refer the client to based on symptoms? | Involuntary hospitalization | Psychiatrist | Marriage Family Therapist | Family Therapy | (A): Involuntary hospitalization
(B): Psychiatrist
(C): Marriage Family Therapist
(D): Family Therapy | Psychiatrist | B | A psychiatrist would be beneficial for treatment of the client's anxiety, especially as medication may be needed at this time. Therefore, the correct answer is (D) | treatment planning |
93 | 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. D... | 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 ... | 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 h... | You want the client to know that you are listening because he is expressing strong emotions and you want to support him. All of the following demonstrate therapeutic listening, EXCEPT: | Refraining from the use of “mm-hmm” and similar responses | Identifying and discussing verbal/nonverbal inconsistencies | Attentive silence | Mirroring | (A): Refraining from the use of “mm-hmm” and similar responses
(B): Identifying and discussing verbal/nonverbal inconsistencies
(C): Attentive silence
(D): Mirroring | Refraining from the use of “mm-hmm” and similar responses | A | A balanced use of affirmative sounds (“mhmm,” “yeah,” etc). lets the client know that you are listening to him. Be conscientious about how often you use these responses because they can be distracting, may appear as though you are rushing the client, or may appear as though you are disinterested. Silence generally does... | counseling skills and interventions |
94 | Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of... | The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thou... | First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separatio... | null | Why would the psychiatrist you referred the client to prescribe a low dosage of Paxil? | Address her panic attacks | Address her anxiety | Address her insomnia | Address her forgetfulness | (A): Address her panic attacks
(B): Address her anxiety
(C): Address her insomnia
(D): Address her forgetfulness | Address her anxiety | B | Paroxetine (Paxil) is an antidepressant used to treat various mental health conditions in adults, including depression, anxiety, and panic disorder. Therefore, the correct answer is (B) | counseling skills and interventions |
95 | Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual | Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by... | Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved ... |
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older si... | In assessing for Social Phobia, which is the best description of Mary's presentation? | Avoidance causes clinically significant impairment in social functioning | Persistent concern or worry about people noticing her anxiety | Mary is afraid of getting sick by others in public | Complex grief has developed into severe social phobia | (A): Avoidance causes clinically significant impairment in social functioning
(B): Persistent concern or worry about people noticing her anxiety
(C): Mary is afraid of getting sick by others in public
(D): Complex grief has developed into severe social phobia | Avoidance causes clinically significant impairment in social functioning | A | Mary's contributing factors to her social anxiety are numerous, however her response to her fears is the same in that all are subject to her avoidance. Therefore, summarizing her symptoms because of specific factors (such as in answers a, b, or d) is not the best choice. Therefore, the correct answer is (C) | intake, assessment, and diagnosis |
96 | 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 ... | The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed... | All of the following are helpful cognitive behavioral therapy (CBT) techniques to manage the anxious thoughts that lead to a panic attack, EXCEPT: | Reframing | Progressive muscle relaxation | Radical acceptance | Thought stopping | (A): Reframing
(B): Progressive muscle relaxation
(C): Radical acceptance
(D): Thought stopping | Radical acceptance | C | Radical acceptance is a DBT technique that does help with anxiety because it is about seeing the world how it is and accepting your reality, but it is not a CBT technique. Although acknowledging that a panic attack is occurring is helpful, it takes away the individual’s power to change her situation if she simply accep... | counseling skills and interventions |
97 | Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9) | Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tang... | You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his pr... | ntly. Family History: The client has an older brother who transports the client to appointments and periodically checks in with the client. Hospital records indicate that the client becomes increasingly agitated during visits with his parents. The hospital social worker noted that his father was critical and dismissive... | Which of the following medication side effects is the client experiencing? | Akathisia | Dystonia | Tardive dyskinesia | Parkinsonism | (A): Akathisia
(B): Dystonia
(C): Tardive dyskinesia
(D): Parkinsonism | Akathisia | A | The client is experiencing akathisia. Akathisia manifests as nervousness, restlessness, tension, and creates the need for individuals to feel like they constantly need to move. First-generation antipsychotics, such as haloperidol (Haldol), are commonly associated with extrapyramidal side effects (EPS). There are severa... | intake, assessment, and diagnosis |
98 | Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Loca... | The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and... | First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult... | The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client repo... | What is the value of recommending the client keep a mood journal at this stage of therapy? | It assists her in becoming more introspective rather than too externally focused. | It allows her to identify triggers for different emotional states. | It enables her to practice becoming more aware of her feelings. | It helps her to identify the frequency of the moods she is experiencing. | (A): It assists her in becoming more introspective rather than too externally focused.
(B): It allows her to identify triggers for different emotional states.
(C): It enables her to practice becoming more aware of her feelings.
(D): It helps her to identify the frequency of the moods she is experiencing. | It allows her to identify triggers for different emotional states. | B | Identifying triggers is essential to helping the client curb her mood dysregulation. This is particularly the case for those on the bipolar spectrum. Journaling helps control symptoms and improve mood by assisting with prioritized problems, fears, and concerns. Tracking symptoms on a day-to-day basis both helps the cli... | counseling skills and interventions |
99 | Initial Intake: Age: 45 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual | During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that ... | Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she... | null | An important area to gain more information on at this point is? | Source of anxiety | Cultural factors | Financial situation | Social support | (A): Source of anxiety
(B): Cultural factors
(C): Financial situation
(D): Social support | Source of anxiety | A | It is evident that Li is distressed enough to come to counseling even though she believes she is putting herself at risk and maybe cannot afford it. Starting with the source of her anxiety is important. This may lead to discussion about the other areas which would all be discussed during a comprehensive intake. However... | counseling skills and interventions |
100 | Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Sta... | The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview an... | First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client wh... | The client says she is only poor at reading and "good at everything else." She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that,... | When developing a treatment plan for this client, what approach has the most likelihood of success given her diagnosis? | Creating a treatment plan that is focused on decreasing anxiety | Creating a treatment plan that prioritizes postponing gratification | Creating a treatment plan that seeks to address social deficits | Creating a treatment plan based on the skill-building and identifying strengths | (A): Creating a treatment plan that is focused on decreasing anxiety
(B): Creating a treatment plan that prioritizes postponing gratification
(C): Creating a treatment plan that seeks to address social deficits
(D): Creating a treatment plan based on the skill-building and identifying strengths | Creating a treatment plan based on the skill-building and identifying strengths | D | There is no "cure" for Specific Learning Disorder, but clients who are struggling with a learning disorder can improve their skills and explore alternate methods of learning that are based on their unique strengths. Therefore, the correct answer is (C) | treatment planning |
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